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HomeMy WebLinkAboutO'Neill, Timothy s o�oSUFFot�.�oG ELIZABETH A.NEVILLE = y� Town Hall, 53095 Main Road TOWN CLERK co y P.O. Box 1179 REGISTRAR OF VITAL STATISTICS �y • �� Southold, New York 11971 MARRIAGE OFFICER O 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. 3132 R Residential x Non-Residential Fee $ 10.00 Septic x Cesspool PERMIT ISSUED TO: Name : TIMOTHY O'NEILL Address 1: 245 JAMAICA AVENUE City St zip MEDFORD NY 11763 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 #R10-01-0027 Name Of Owner O'NEILL, TIMOTHY ------------------------------ Mailing Address 1 245 JAMAICA AVENUE ------------------------------ ------------------------------ City St zip MEDFORD NY 11763 -------------------- -- ---------- Property Address 1 555 JACKSON LANDING ------------------------------ ------------------------------ City St zip MATTITUCK NY 11952 -------------------- -- ---------- Tax Map No. section 113.00 block 5 lot 5.000 ------ --- ------ Cross Street WEST MILL ROAD ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 1/29/04 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) e F 0 0 ELIZABETH A.NEVILLE �� G�� Town Hall, 53095 Main Road TOWN CLERK H P.O. Box 1179 REGISTRAR OF VITAL STATISTICS �y • !� Southold, New York 11971 MARRIAGE OFFICER O Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ��( �a Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK 09 17 M TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: December 17, 2003 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 3267 for a Cesspool/Septic Tank Construction Permit submitted by: Timothy O'Neill Please review the application and location map and advise if this office may issue the permit. Please complete the form below and return it to me. Thank you. * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: / APPROVE DISAPPROVE Comments: \ �Gi Signature Dated a . 1 ttcc O`OSUrfo`�� ELIZABETH A. NEVILLE h`t`V �G.j. Town Hall, 53095 Main Road TOWN CLERK p P.O. Box 1179 CA Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICS v. A� MARRIAGE OFFICER Gy 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 ?6or Non-Residential @ $25 Application No.`3a Permit No. Applicant Name 714W_ffy 0,41W"" Applicant Mailing Address_ 2-4-S (/67 /9POA/`/, G3 Septic Tank or Cesspool / Brief Description of Proposed Construction or Alteration �CGI� �NSG�y Location of Proposed Construction/Alteration: Owner of Property: l �m_o % qvR4_-'�4 Owner Mailing Address: 2¢_S f/ l/q'�G� �/i �d /j/��� 3 Owner Property Address: SSS r `ya Name and phone number of contact person ( ►^I - 631 654 316'6 a- Z's Z 6?4z- Tax Map No: Section Block S Lot Cross Street we s 7T A - NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH IREALTH DEPARTMENT APPROVAL "kA�j� /2- ( -D Signature of Applicant Date Received by: SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES �L�'U6 DWQ(L/tilLy—v�ELL 1 f4 nl'T -10 `N FR77cp,v `� R SUFFOLK'\-.' ego 34'-f0'l� t 22� !05.OG7 SERYICES a1 /V PERMITFOic. . r :.. :,,YuCi-O^ FORA !-- 2• dy- P IE TRC �. 2l.4 • SINGi.:. f'... f ;�Y 1 DATE CO APPRovED 4 \ ATlON PNSPfCTfON REQUI FOR MAX1MUt�i f) .. ,� L<, ; .Y�t 8ANl1'AFiY SYSTEM EXPIRES THREE YEARS FRWO O G E.,',- Q �'�.LTH DEPAaRT NI-?!�T - ti 79 ¢" N O T E S z3TEST HOLE Q b L', 1) SAME AS DIST: /000 SEC..: //3 BLK: 5 TOP_OF T.H.: eL= IE,./ LOT: S ON SUFFOLK COUNTY TAX MAPS. oSE� / V W tl � c� � 2) THE EXISTENCE OF ANY RIGHT OF WAYS AND OR EASEMENT QRowwf s1aTv V, OF RECORD,IF ANY NOT SHOWN,NOT GUARANTEED. moan. 2 4. rr,. 1 y 3If �,/ � � BKevY� C-oANY I Gaa Q 3) ELEVATIONS ARE SHOWN IN NbVO. IR29 DATUM. PaiE errcw�i 3 O m Q 4) THE LOCATION OF WATER SUPPLY AND SANITARY SYSTEM. L=43./5 N S l 1 0 a 0 SHOWN AS PER ADJACENT OWPI RS ,NOT GUARANTEEDrz e e,e sA ro 9 2 ~' `A e --_j = PROPOSED GRADES. WATCR PALA AW�4 lb Ni �O• ,'4_ B) ZONE.a- R ..40._.. :S/4-TY`SAIJO 71 O d ��vd W.arcrr 1j pace n LOT AREA - 204q �'F _eaeW14 FINE SAMD a •� I n CC-RPA-16-0 ONLY To IN ,Q i) SANITARY SYSTEM FOR UP TO(4)FOUR BEDROOM HOUSE 43' j a�1JJ G'ioeLrTY NATigNq[.7/T�/NS co or-u•`!. SEPTIC TANK=10M GALLONS. SAG& NARBoR T f7LE .44eAJC--y,LTD 4•�2 7/y oTN-I J. O'MEL-L 'UNAUTHORIZED ALTERATIONS OR ADDITIONS TO THIS SURVEY IS A VIOLATION OF SECTION 7209 81' OF THE NEW YORK STATE EDUCATION LAW. *TH. 1 -COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL SHALT.NOT BE CONSIDEREDTO BE A VALID TRUE COPY. 4Q �•�� I -CERTIFICATIONS p4WATED►AEON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS ,ae- ( lz 3'9G ell- PREPARED,AND Oft THEIR—---- -- EK sr INSITTU FION LISTEDOIrFCPRICTO ATIONS O ADDITIONAL E TITIJE COMPANY,GOVIERNMENTAL AGENCY AND�NDMIq 125't /D� R Z� was weu TIF INSTITUTIONS OR SUBSEQIIEM OWNERS. C/G �� o•c`�> V m �c q7 \ 'THE OFFSETS FROM PROPERTY LINES SHOWN HEREON ARE NOT INTENDED TO GUIDE IN THE p LTi € /4T5q /� 00 e `Z'T ERECTION OF FENCES,RETAgMG WALLS,POOLS,BLDG.ADDITIONS,AND OR OTHER CONSTRUCTION. © COPYRIGHT BY ROBERT B.HOLZMAN L.S.,AS PER ORIGINAL DATE SHOWN ON SURVEY. S U R V E Y 641L�L--r :5/G WEu OF: Z-OT Zo MAP of bATec=' 16-N � � DHTI; o>`FrL/NCy : MA MC H. 28.., L969 f=/CE�/RPNO 5280 MATT/7ZlGK , 7oWN of CJTHOr.o , SU_FFO[.K CocJNTY,.. NEvV BY ROBERT B. C N �, LICENSED LAND SURVEYOR , N.Y.S. LIC. #49176 '" 12a5 WALNUT AVENUE BOHEMIA , N.Y. 11116 2-0 3 : f2B J e�c-oG. _ {c P� i,' �z r 8-1 ` 5-1-o3: RE /. Sc.140 /ti1Fo � REd. BL.OG• _ PHONE # : 631 589 0261 FAX # : 631 589 4930 f4S-of �-'A-R7'15 grx),D , /JO FIE{-D UPDATE _ 4-fo-0f : PCvfs�e4DATE : � /2, 2 $GALE : 111 = �' FSE ;lGi�O- /13- 5-S ` 2-13-0! RE�/r S� SAN. 3YSTe1✓! FER x H� cp-•('-/e nl TS SCNC RPF� r4/O-C3/-0027