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HomeMy WebLinkAboutGlasstein, Jason • ELIZABETH A.NEVILLE � ?.. Town Hall, 53095 Main Road � c g � TOWN CLERK N Z P.O. Box 1179 iv?',� Southold, New York 11971 REGISTRAR OF VITAL STATISTICS " '1ijI O�11 Fax (516) 765-1823 MARRIAGE OFFICER Ol4. �a��ll Telephone(516) 765-1800 RECORDS MANAGEMENT OFFICER .• .0° FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1916 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : JASON AND NAMEKI GLASSTEIN Address 1 : P. O. BOX 643 City St Zip SOUTHOLD NY 11971 Descripton of Proposed Construction or Alteration SANITARY SYSTEM FOR SINGLE FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. REF #R10-98-0105 Name Of Owner GLASSTEIN, JASON AND NAMEKI Mailing Address 1 P. O. BOX 643 City St Zip SOUTHOLD NY 11971 Property Address 1 ORIOLE DRIVE City St Zip SOUTHOLD NY 11971 Tax Map No. section 55.00 block 6 lot 22.000 Cross Street TUTH I LL ROAD EXT. Building Permit Number Cross Reference: Issue Date: 8/19/98 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) DNp co, • ELIZABETH A.NEVILLE •�`1` Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 y 2 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS %� # Fax (516) 765-1823 MARRIAGE OFFICER y 0��� Telephone (516) 765-1800 RECORDS MANAGEMENT OFFICER .7491 FREEDOM � FREEDOM OF INFORMATION OFFICER ma- /////�l OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: August 14, 1998 Transmitted herewith is a copy of application No. 1993 for a Cesspool/ Septic Tank Construction Permit submitted by: Jason & Nomeki Glasstein Please review the application and location map and advise if the project has received Suffolk County Health Department approval and if this office may issue the permit. Please complete the form below and return it to me. Thank you. 44-1(-64-4"-- Linda J. Cooper * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE .. DISAPPROVE Comments: /C) Signat e 5q, Dated / r OFFICE OF THE TOWN CLERK VW TOWN OFSOUfHOLD *% 0-- Application No. 16193) FLIZABETH A.NEVILLE,TOWN CLERK '�� $10.00 - Residential P.O.BOX 1179 SOUfHOLD,NEWYORK11971 0 *.$ $25.00 - Non-Residential Telephone SON's (516) 765-1801 - TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICAT ION for attiMatf IVO 0 SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ fIPPLi , DATE TM cla'' OWNER NAME: .3,45©10 `t- NOM EK1 GL ,4SSTEI N OWNER MAILING ADDRESS: ?LO. Bo ( (p L{3 SokYTN--O LDS N ,f. 11911 I OWNER PROPERTY ADDRESS: M{R,►d L E `)K1 U E SOUTH-OL, N ="(. OWNER TELEPHONE NUMBER: TAX MAP NO. : Section 1000 Block 55-QC,, Lot CROSS STREET: `TOT%+ I LL_ R P.. ExTE-NTI oN TYPE OF SYSTEM: Septic Tank 1 New ti/ Existing Cesspool \V New J Existing Residential ti Non-Residential LOCATION MAP: Must be attached hereto before permit may be issued. (Locate building and system; give north arrow and feet of distance, approximately, to building and closest road.) /Signature of Applicant RECEIVED BY: C t,.._ T, n Clerk's Office DATE: IU ' wRIER l"44 *-- ----w w=—"'�" 22.2. 22.1' DRIB ORIOLE582'34'20 w . N Q,'.34 2Q 22.. • v) ...------- 113. 0 0 A" q 1.3 Z P'pi,4 wia w Sy_ite'n t o • ,p � VI Lot 21 . P( C 2* (dwe"In oa 24' h. pz' Lot 23 (dwelling) The localisms of wells and cesspools Lot 22 shown hereon ore from Held observations and or from data a'lotted from others. ar pipe 4 •1. o, A 1 ELEVATIONS REFERENCED TO AN ASSUMED DATUM ZO g), @vie"' r .40 to 041 CRV��10H E� �_ g�kp'S 22.4' 22s 50.39* p.7La • y� '. 19 27 N\ gral \ 0* and wit Lbw c� i' ` ANY AL TER, TION OII f''1 , wf34 . �. OF SECTION 7209 C SUR VE Y OF LOT 22 "HIGHPOI N T MEADOWS. SECTION nVON ° ,. FILED MAR. 19, 1990 FILE NO. 8911 AT SOU TLD TOWN OF SUTHO LD SUFFOLK ,COUNTY, "Y, N. Y. f 100A-1S--46-4" 16.25 40 © 4Q . O Scale 1 = 40' JULY 9, 108 O , Z SUFFOLK COUNTY DEPARTMENT OP HEALTH-SERVICES ptpJfT FOR APPROVAL OP C INSi'RIJCflON FOR A NGS USE PUBLIC WATER SINGLE FAMILY I « ONLY DATE �' — HS RBF.NO. AI. 9 ' • APPROVED 1"-#7.FOR MAXIMUMOF • EXPIRES THREE YEARS FROM DATE OF APPROVAL Im..ri. CERTFI.ED TO, FIDELITY AO TITLE NVSURANCE COMPANY OF NEW YORK JAS IASSTE'Nil ��p NEW y0P D�Hyy SP1�r $ ' ' `Q• 1. M E TZC )4' C)--� ` II�t7 ` E F M I E l 4p. _ .�£ Ho a /at term Moieht ant on Km * 1.4 1998 t l` .,,x . OC s t ) THIS SURVEY IS A VIOLATION P ; i:+ °e a`?` p.C. Vet( STATE EDUCATION LAW (51.6W A