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HomeMy WebLinkAboutYaxa, Dean „IS�F FO(�BOG. ���� y� Town Hall, 53095 Main Road JUDITH T.TERRY � � TOWN CLERK P.O. Box 1179 Southold, New York 11971 REGISTRAR OF VITAL STATISTIC',S ‘O. # MARRIAGE OFFICER �` a7. , Fax (516) 765-1823 RECORDS MANAGEMENT OFFICER 0.( * d Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER .��,,, ,•1” OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1432 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : DEAN YAXA Address 1 : 8 FERN PLACE City St Zip GREENLAWN NY 11740 Descripton of Proposed Construction or Alteration SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. SCHD REF. #52-5-60.2 Name Of Owner YAXA, DEAN Mailing Address 1 8 FERN PLACE City St Zip GREENPORT NY 11740 Property Address 1 COLONY ROAD City St Zip SOUTHOLD NY 11971 Tax Map No. section 52.00 block 5 lot 60.002 Cross Street ALBERTSON LANE Building Permit Number Cross Reference: Issue Date: 1/10/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) / qJ 1s % JUDITH T.TERRY t, 0 fit Town Hall,53095 Main Road TOWN CLERK i H Z ; P.O. Box 1179 %+0 *.' I Southold,New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER =q2, 0- Fax(516)765-1823 RECORDS MANAGEMENT OFFICER .� � `1► ��1 Telephone(516)765-1800 FREEDOM OF INFORMATION OFFICER - o•..�• 00 OFFICE OF THE TOWN CLERK 'i R � O _ L; TOWN OF SOUTHOLD JAN - 41996 TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office BLDG.DEPT. TOWN OF SOOT-v. r DATED: January 3, 1996 Transmitted herewith is a copy of application No. 1488 for a Cesspool/ Septic Tank Construction Permit submitted by: Dean Yaxa . 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. Linda J. Cooper * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE e./— DISAPPROVE Comments: > y,,(44..jyttits9 .rC 32 -6--- 2 GO, Sign tu�� �7 �� y' 9 6 Date OFFICE OF THE TOWN CLERK � ,,s' Town of Southold 00fOLke, .. �k Judith T. Terry, Town Clerk �. R� l/y�; Application No. �f Town Hall, 53095 Main Road • • Construction P. 0. Box 1179 : = +• ell ' Alteration Southold, New York 11971 :y0�� �C � $10.00 - Residential Telephone r. (516) 765-1801 : "/ 4 �, ' $25.00 - Non-Residential ._ ,s . ••• TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL • Permit No. Fee .$ (�f DATE APPLICANT NAME: T e, j Y g.-it A- APPLICANT ADDRESS: 1 ex) PL Ggei_>il Auf 1.1(1 in 1y6 SEPTIC )( CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION 4e. Ala A-V cc44,41 ,E5 /®F bGz oA-i acpz e;s- LOCATION MAP; Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRU ION OR ALTERATION: OWNER OF PROPERTY: Cyt OWNER MAILING ADDRESS: g F E,r° P(— Gr EE OL—Au,�✓ �• ( • 1 \1*) • OWNER PROPERTY ADDRESS: 0610,v1 Rb + ALBF2g'©Av LA Ur-1. TELEPHONE NUMBER OF CONTACT PERSON : 5/(o - 75q-02O 7O TAX MAP NO. : Section 05c9, Block S Lot 6 O,(9., CROSS STREET: 4 f,Ef' o ,t> C- P► MC— BUILDING rBUILDING PERMIT NUMBER CROSS REFERENCE : Signatu e f Applicant RECEIVED BY : h( C Town lerk's Office . DATE: /7 /(C.16 . ., . ., . , •. S. . ••• . ' . . . - . 1 0••••••••.• _.,...____ .. - 5. ..1:1;ft.t. 14 • - -- --------c-Eir--.)Nry ,. . 12,94a, ,, , .-risci-96€. _ . -- -.J.'. 1 PREt1/585 (SEE E' Att-) . gf,-4.212, 64LAF.2„A).„Wqtagt • - , \ ,4-111...,-- :. ILOI II. ii,—/‘ : ' ', . ' • - t.-0*• •-•a'tie BP. " , p i ; WI i 1 r.-7---:----. ; CoPIN . -," r t i ' ' • P9,, 1 . , j v--11.- , 14,0 #C.2E5 •' ' _.-Y'° ----1:-"-14e4t•*stI' - (- • . . ,. .e ,--4967. 1 . I --J 04 1 ! W 3 0 2 ,Nick:\ , • C.) .4 u . "A ,....., I 0 44 , , , . ( "N....- ."-- .. • i ------ • JJ ' ' -. .. . f ...._____ St r r V‘\.N1.- C314 I \ 1 , • \ . 1 i , kpin 6 MAP QF PR.OPERTY Sti IZV EY E f) EP . i . / ArICHAMOMAPVe i TOWN OP SOUTH 0 1...P i_. NY m()MAQUE P0741:1 ill Pr• [ S. _442.3 1 . ......---Fia.: "'":;.7 1-1 r•-.:77:".""."-----12-7-7--.. .)'''z,'..,,77-/ 4, 1 - i'-/) ''''' - .' S — ..". V..• ‘..-( V' .1(,t - 3•5 I f.esq-ric T., 4.$ . . . , • , , 1 - slaLa4= • . l • i:r" % r3. ..- . _. -. ,.1 4 1 : . . . . ! , jij.: - .. . _ , ! . . , ' sAtsio.-]-f ..i. •'..,,,,' ' 410. -•;.* _ . • • • .. '•if POT' NI132/ .., , , • t — — ----- , ,,c___, • SUFFOLK CO HEALTH DEPT. APPROVAL I(, _ _ __ . _ _ ______ - -- - --_ -c H.5. NO. . __ ____ _______ 1 r` (ZO AD ' n , o ki -, t•;.17'SO'9.0.‘E. 625.66 0 --, ..., 0- , 1 -----i-1 -t-,' itt+31E, FAMILY DWELLNG ONLY 55 , ' coN'TOU125 FI2:0M SUFV„,, "\\92.0,,...,,ELL ..,-- • ' - (.... a. TtiREEsyEAR5,-FIVM DAIEDFAPPROVA, sztz,Avizap,Lv„,vauel, . _,..,: - : 121 / / \ ' E ,:, DATLit-1: '1'..).G.\/,.0. - .- ' ___ , ... ... ' i v:ILL. 1 ----------11 k:-)11-Dit ,••$_LTp..p IN pc r so'- - 7 - ----174'4 --- 1 I STATEMENT OF INTENT 15 ,t-t-000 -- .1, Bs • 17 / ex.Rw• i i THE WATER SUPPLY AND SEWAGE-DISPOSAL WINN 14 - - 's?'' f r—-- .----- -Vti, PiZ.OF .91EpTic. tli • . iii".'./F-- 140USL-1 , / 'Ft li CONFORM TO THE STANDARDS OF THE 1 i _./. 1 SUFFOLK CO. DEPT. OF HEALTH SERVICES. ___ . ,.3.,,," •,' / ,..."'', "4--; Ill , ). -' ' a.Sialt , I 41 • . . 1 _ '_a,•44 " ,.4:1035,-.SEPTc....:, 'T.- . 8 .<--. ., --.-?,0-:"._,I,::.- :: . ,. , .SUFFOLK• :COUNTY aDEPT. tot '•.ftg.!tt.ITH ' . , . . . . .. . .. . . ,., . - • •- .-----—— - • -. , •-•.. :' - . .-.- • , ,., , -., - .. . 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' -APPLE:I:ANT::THIS RESIDENCE N ici. _co TEST HOLE STAMP ‘,0 / i Ni g .4;- ii (\• Uneuthodded addimiled de*deka to this sway is'viols"'01 (ii uesi. ' SYSTEMS soctieri 7208 el ilgonvvec4 stir. n . ..azos,Art4. eduomsaa Las. \ > , • o c aro'isodot , copes , ,i 2 the mnd sumeYees inl'ed ____,,tr." . 0 MAP OF // b.•var.t......,. P-12.0PEPTY Guarantees in:Wood bereon"dhed run SURVEYED FOR /L. DETAIL . 1.3:rc..y, es prepared.and an Ms demi ammo. DEAN 'AA A , ...,1 suailic)otii. 1:3140t4,UP4e6ST tution.Guaranbeses .. sublinwt . AT -4 , • • 119- , . Itift71:12t1J to Elation&irstouttonoor . 1 4-- AriENCED--iut..v 25,199s ' '‘se4soiswieri, / ; . ... 9' . . ,. . -- •••-— wtonding- 'nstluuenb:d....":.....n° 4.,: uuecarnPan:mign....gn""vnerdsionnosfrsfr,a -ald VOCCECLI,V..\.• ,,P ,Of N _ , ... ' . - • ' ' ' ,....=tr :iNKNairittiNA -, l'‘ii-C<SACK V•14. 1.-ss fr Ftiol.'a di. .•.,1111 - ' - . ..or-Ar,ipt:140.-4002,:friev ' Pali' luomg4";.: ico-• g-• .4 , t 13\ , . 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