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HomeMy WebLinkAboutJonson, Todd S l o�osuFFot�.�oG ELIZABETH A.NEVILLE �� y� Town Hall, 53095 Main Road TOWN CLERK y P.O. Box 1179 REGISTRAR,OF VITAL STATISTICS %0-10y • �� Southold, New York 11971 MARRIAGE OFFICER Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER ��,( .��� 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. 3126 R Residential X Non-Residential Fee $ 10.00 Septic x Cesspool PERMIT ISSUED TO: Name : STACEY BISHOP Address 1: 150 WATERVIEW DRIVE City St zip SOUTHOLD NY 11971 Descripton of Proposed Construction or Alteration SANITARY SYSTEM FOR ONE FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. REF #R10-03-0119 Name Of Owner 70NSON, TODD ------------------------------ Mailing Address 1 819 LINNETT STREET ------------------------------ ------------------------------ City St zip GREENPORT NY 11944 -------------------- -- ---------- Property Address 1 140 LINNETT STREET ------------------------------ ------------------------------ City St zip GREENPORT NY 11944 -------------------- -- ---------- Tax Map No. section 40.00 block 3 lot 3.000 ------ --- ------ Cross Street 9TH STREET ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 1/29/04 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) R �o�o�FFo�,��QG ELIZABETH A.NEVILLE 'y Town Hall,53095 Main Road TOWN CLERK y P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICERFax(631) 765-6145 RECORDS MANAGEMENT OFFICER y�Ql �aO! 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: December 3, 2003 Transmitted herewith is a copy of application No. 3261 for a Cesspool/Septic Tank Construction Permit submitted by: Stacey Bishop for Todd Jensen 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 1,2-105- Dated 2- DSDated o�suFFot,�� ELIZABETH A.NEVILLE Town Hall, 53095 Main Road TOWN CLERK O P.O. Box 1179 ti Z Southold, New York 11971 REGISTRAR.OF VITAL STATISTICS v. Al MARRIAGE OFFICER Oy �•� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICERTelephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER O'� �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 @ $10J� _or Non-Residential @ $25 Application No. bI Permit No. Applicant Name S i`n ct y Applicant Mailing Address 4v i vrzc' Sye-9vey rd is✓G J /cK. AY-0 (JA_�_L VIC .11 Septic Tank or Cesspool ' Brief Description of Proposed Construction or Alteration � -� Gws,4 uc�1✓ Sr ti�cc. .M 11,.E �'w'vl--Lt rtl�o Location of Proposed Construction/Alteration: Owner of Property: 7u o 0 �j c;,). Owner Mailing Address: 9-15 Owner Property Address: S'ron.t`= I '4 b I,,, n nle..k Name and phone number of contact person SMQ-y atjAce 2 G,J` C 217 Tax Map No: Section Block ?, Lot - Cross Street Cy 1k S NOTE: LOCATION LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH. EALTH DEPARTMENT APPROVAL 4JIA�4 of Applicant Date Received by: 51.JRVEY OF .LOT 6-7 PLAN O� �ROfi��1`T I O� �Y�'�-FOL'iC COUNTY©EPA�R7�1EN!'OF HtALTH SERVICES t f PARK PERMFOR APP&OV.�L OF CONSTRUCT'it)N FORA CTR �t�I- O IST DR� �C7 I- R TT TLE FAMILY RESIDENCE ONLY ' FILED DECEMBER I, IciOq FILE No. 36q _ 51TUATE: &R�l�ll''ORT I DATE �` opsO/1t15 a TOM: 5OUTHOLD APPROVED SU —OL COUNTY, 1�1Y - FOR IJiAXL'ViiJNi OF .BEDROOMS SURVEYED 01-15-03, P OP05ED AGTION 05-06-03 EJ Ptd THREE YEARS FROM DATE OF A7ROVAL SUFFOLK COUNTY TAX 1000-48-3-3 d Lot 68 we I� IiZr public CERTIFY TO: mac an t DIANA JENSEN VaG an t TODD JENSEN Tr 0 w water service EL.141 — ------------O FE — w EL.14' 90 f 2 46 Orr 50 ' VA �N1P -BSP R 2 I51�GABY ^EL.14'F" tB ESSYST-EM u� . . ' 0 i �- O N ► IQ ' 51 L U)m� . N d ing one we I I ' � ^I cove I municipal ' Water � sewer cools to be TEST --Q d bQ Wined_ obW HOLE -- — —_ with clean sflolnd cast iron d cover d a FE 2.5,w I Proposed I 0 ° House 6 M Lot W I5_, c� 0 25' h dwell ing GOn� U 0 MUnic i al W /ylcl cover) ►^ Lot 66 ater power .. ti°Lot 0 dwe ll in EL t-�4e i I 'w public a vl W er I �3�'0 l.fj 1 ry �-- m m i I Ston Bon M� --- 0I i i=r fi _ z ' hse HOU�� =° 5­­ ° ' T'r, ns.� House t0 5M - - 22 1 b Removed W"h -- e ed "- Grwal FE Brown e 2.2'5 woo 0_� _EL.141 Goorse sw 2.9w d fence--0__ ---_._------ saTa 8.7' 4�Q46�, FE ---- --—_ _ o uT O rrW SO.I j Woter n dna sw Lot 4 f 7o Coarse I s«,a Lot 14 s 15' mUnicl Water � pal � Lot 12 Sewer dwe II in � dwe ll in j public Wc�?er Public Wa er I NOTES: Of NEW yo • AXLE FOUND ��Q' G. Umt wrl,ed qI a quo q q It tq­y ay nap bearNg a Ikensetl Imd eywm sea1.11L is a + p PIPE FOUND viglgt m qr,actio f=, dNl>lon-1,ar L N.w ro.i<sk M Etluwt on Lw' 'Only I from!ro or MI of thl>>vry GE55POOL5 TO 5E (2) 10' DIAMETER .k , * mond:, gIg4gIofp :—srr,eyor* strrrpetl seal!boll Ib con!Lde to tab volld Ove 5' DEEP CESSPOOLS 3' AE0VE SEASONAL opie>• O "Lertlficotlon>Intllcgtetl roraon>Ignlfy that Mia HIGH GROUNDWATER �• > ay„ea p epor,In­grtivrce wi ems`e.- I ting or for L—cod prgctice s,,,,ey> tlopted by khe New Yak State Aa>o t'on of profe9>lornl ALL DWELLING5 WITHIN 150' OF PROPOSED �F . J to �.p.;an,grwnomSo. rror>t ey-1 opo ed -f� aitl on hl>txholf to tro tl[ —pon,20 SEPTIC, ARE GONNEGTED TO MUNICIPAL WATER�`V' agency and bntling I atiWLq I—d he eon, to tro gsslgnea.or u.e leMMg I,nutatlon,ca.aifwo- [Ions ora not t—f—ble to—It—,MtRvtlors ELEVATIONS REFERENGE S.G. TOPO MAPS AREA = 5025 5F OR 0.13 AGRE5 JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S.LIC.NO. 50202 GRAPHIG SIGALE I"= 20' _ RIVERHEAD,N.Y. 11901 369-8288 Fax 369-8287 REF.\\Hp server\d\PROS\03-218.pro