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Home My WebLink AboutRosin, Steve ` �o�s�ff0��coG ELIZABETH A. NEVILLE 'y� Town Hall, 53095 Main Road TOWN CLERK CA Z P.O. Box 1179 REGISTRAR OF VITAL STATISTICS 0-0 Southold, New York 11971 MARRIAGE OFFICERFax(631) 765-6145 RECORDS MANAGEMENT OFFICER 0,� �aO� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3120 R Residential x Non-Residential Fee $ 10.00 Septic x Cesspool PERMIT ISSUED TO: Name : STEVE ROSIN Address 1: PO Box 373 City St zip LAUREL NY 11948 Descripton of Proposed construction or Alteration SANITARY SYSTEM FOR ONE FAMILY DWELLING. ;.PPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. REF #R10-03-0110 PIame Of Owner ROSIN, STEVE ------------------------------ Mailing Address 1 PO Box 373 ------------------------------ ------------------------------ City St zip LAUREL NY 11948 -------------------- -- ---------- Property Address 1 655 HORTON AVENUE ------------------------------ ------------------------------ City St zip LAUREL NY 11948 -------------------- -- ---------- Tax Map No. section 141.00 block 1 lot 25.003 ------ --- ------ Cross Street \ ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 1/29/04 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) ELIZABETH A.NEVILLE _�� OGy� Town Hall,53095 Main Road TOWN CLERK H P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICEft ,f, Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �Ql �a� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: November 10, 2003 Transmitted herewith is a copy of application No. 3255 for a Cesspool/Septic Tank Construction Permit submitted by: Steve Rosin 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. Linda J. Cooper * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: Signature /D d Dated s • .- �OSUFFO�,�c ELIZABETH A.NEVILLE ,``1� �Gy Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 y Z Southold, New York 11971 REGISTRAR,OF VITAL STATISTICS Ir- MARRIAGE OFFICER • Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER 0'� �a southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential $10 '. /or Non-Residential @ $25 Application No.3)_ � Permit No. Applicant Name /V Applicant Mailing Address f?O �X 373 zwe""'1 6C Septic Tank or Cesspool � Brief Description of Proposed Construction or Alteration Location of Proposed Construction/Alteration: Owner of Property: f72tit i�csi ti Owner Mailing Address: Xe a ue 573 6-c . Owner Property Address: .�. �- h('e— Name and phone number of contact person Tax Map No: Section Block Lot 7-5-. 5' Cross Street NOTE: LOCATION MAP MUST BE SUBMIT WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WIT TH ARTMENT APP OVAL Signature o Applicant at Received by: �1' WELL _ �... .._. @1/4'/FT. 5CVH5 APPROV (2) 10,000 GAL. SEPTIC TANK 5CDH5 APPROVED PPECA5T 8'RJ LEACHING POOL SEPTIC . f GRADING PLAN NT5 5EPTIC rLnitan sY _ . q III 5EEPTTIIC ent �� essed by 99 6� Ste, W be w WELL �00 l \a� WELL •� `t°��C / or / /9t d \ Z�1 I �/ C/ 1o?, \4 cK O � �O \ SEPTIC \ N I \ AUG - 1 2003 2 / ffSAVbu► Mc"s 9`00` � 2W,PORI�K CO / LA e� 3• h "a \ a . r>No� -= IYwTrALTIMANY , BASED ON SURVEY �j0°° 6 v� oRm" &W WWXAX9 Off FOR: 5TEVEN*AILEEN ROSIN lKnjD WALW%AW MATTI OF 5OUTHOLD Oc' FAI RWEATH ER BROWN LA TOWN OF �� N NEW YORK ` ' g LL BY:A.W.LEWANDOW5KI DESIGN ASSOCIATES,INC. LAND SURVEYOR 205 BAY AVENUE DATE: APRIL 2,2001 TAX MAP.NO. P.O.BOX 521 1000-141-1-25.3 FQ AR GREENPORT, N.Y. 1 1944 9 �L �� G31 -477-9752 (Fax) G31 -477-0973 5 1 T E PLAN 08/01/03 SEPTICV SCALE: 1"=40' F _ I