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HomeMy WebLinkAboutPeters, John T ,,,,,••,., ,. ,o�oSUFFot, �o ELIZABETH A.NEVILLE ,',_� Gyd •`` Town Hall, 53095 Main Road TOWN CLERK ti P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER �� # ����, Fax (631) 765-6145 ,��� RECORDS MANAGEMENT OFFICER -_'�Ol jig 4:00i� 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. 3145 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : JOHN T PETERS Address 1: PO BOX 479 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 #R10-03-0151 Name Of Owner PETERS, JOHN T Mailing Address 1 PO BOX 479 City St Zip SOUTHOLD, NY 11971 Property Address 1 1465 ACKERLY POND LANE City St zip SOUTHOLD NY 11971 Tax Map No. section 69.00 block 5 lot 7.004 Cross Street MAIN ROAD Building Permit Number cross Reference: Issue Date: 2/13/04 Elizabeth A. Neville Southold Town clerk 3/46 , ,o�oSUFFot,�00 t ELIZABETH A.NEVILLE hZ Town Hall, 53095 Main Road TOWN CLERK o P.O. Box 1179 HSouthold New York 11971 REGISTRAR.OF VITAL STATISTICS � v' � MARRIAGE OFFICER Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER y4jig " ,•'' Fax (631) 765-1800 FREEDOM OF INFORMATION OFFICER ,�'� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FEB 1 2 2004 TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: February 11, 2004 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 3282 for a Cesspool/Septic Tank Construction Permit submitted by: John T. Peters 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: y/ APPROVE DISAPPROVE Comments: / v Si ("-9gnature /Y 1 -06-1.641-s /3 X04 Dated 3 . . OFFICE OF THE TOWN CLERK '''c��FFDZk�0 ,�.2L TOWN OF SOUTHOLD �; Application No. ELIZABETH A.NEVILLE,TOWN CLERK P.O.BOX 1179 1•. Construction SOUTHOLD,NEW YORK 11971 Vs, '�T' Alteration Telephone O $10.00 -Residential (63fi) 765-1800 = JO s. $25.00 -Non-Residential TOWN OF SOUTHOLD • SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee .$ DATE E3 • ( ( 7..,00 + APPLICANT NAME: p(r.E M T. PeS s APPLICANT ADDRESS: 17.6 . 134 '449 SEPTIC X CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION J1/2„4_ LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: ..J®1AN „_--per �2,s OWNER MAILING ADDRESS: R•0 • 16)6 41-49 OWNER PROPERTY ADDRESS: 14(.25 ACr .4 .t �x aCTLAb(2 TELEPHONE NUMBER OF CONTACT PERSON: �oFF'��`f �S -k5 t TAX MAP NO. : Section°4'9.0 0 Block 06-00 Lot GO1-. 004 CROSS STREET: r lAI NI BUILDING PERMIT NUMBER CROSS REFERENCE: d 44.. Signat e of Applicant RECEIVED BY: Town Jerk's Office DATE: -2 <i/b� r t 4 ...undue 4 1i. E ■ OF LOT # 4 MAP OF "PURITAN FARMS" 1� N • FILED JULY iq, Igg4 AS * g538 ;, �o9h �f / SITUATE: SOUTHOLp <o'), �o W E •TOWN: SOUTHOLD �c• , SUFFOLK COUNTY, NY •' `P93. sq o0 • • h� ov s SURVEYED 01-15-03, �p /�` qh e� c:,,.,F<Q� e. PROPOSED HOUSE 03-06-03 %"4,x, 0 \got - `la, --- , o, cY /�� AMENDED FOR HEALTH DEPT. 08-08-03Cr / \ -"- Ce^y w SUFFOLK COUNTY TAX # , / ^•\ O `� oi' o c 1000-6�1-5-'7.4 l° e�iq�� j2� ht�► �� kc' �+// �. o / \ •S\• \? 4, o =MOTO: 00 o a 2' b �' �. lo I�AtYPBTi 3 a .( u d, ;' / ° e �J/w'rp_-o � Q \ie..'t � 0((4' \ e ( ,,,...' , :/'%, c. 0/7 o ,` I C Cos CIV c? cP17 /,,0 0 4,,,y „,q o , 1 awn G �o °ems ,' , • • \ qb e PI 24.7 1.12--' \@F '�,� O� j. 77e?ice�o ,,..^.i.. Q , \:.rcr \I //lir: 7" of o ,S y , : n} © r� , .�= , tri `� \m I,� bap • �. N. r-... 0+ \ ' >ts3k, j om _• • O / 4WD+r \ \° �°�* = _�, q "veil:. .SS F�e `�° ve iti, . ,.• c r`J Te ''1-kola p., L io. 0 4+ '. �Q6 ?b-03 1 7:: 0 ,'< erose oL tFT1T QF� ALTHtVICU`w ., \ SUFFOLK " _ DE I1i� • \ Loa+ 1.5' I I t stn \ iiJJ f�''�j �R A ,� `. ' ` �" 1 i. irpx AppRpYAL QF CO ��: Dupe O FIT PERMIT GLL IrAMITrymg>q'CR ONLY ��lle , Sand s,, , I I�- Cs 14 Ws 107.N°, i '%� L �, \ Dt�°1 12.7 Letarund I DATE . Motor hPi •„...964a6 RC Roo sim To R pXIhiUM OF 4...... OpMS ` 9s' \° \p'` Coorso • yEAILS FROM DATE OF APPROVAL �Q ©� ? \ „' g�CPIRES'I'! � \ �.� �dF NEW Y ... 1 , p /' ,.� ,i' �(F ��. (� UwNnrltW alteroLbn T addition t0 G survey V bearing o licensed lora,urwyw-L.ed n o . \ �e lotion of section 1209.sub-dMsen].of dr X 41 Y Hen York Stats Education Lam NOTES: , %, o/ pe ' '' ''.1,1,' any copies Fran,the of of this survey 1 (`�/ �I marked Neil on cri9Frl of Viand a d sweyor,. 1 V 'u ' ,t'.1, .' stamped sed shall be considered b be vaMd tn. I • MONUMENT 1 �•°�i• , * '�.• , ' '0ertskdkas s''`led hereon that= /�/ vey.�prepared b o�arme.Mfi tti er- p PIPE �j'!'� �"sGodev aeyors fro Lisak pled by Ur fins York State♦eSoclatim of Pr ofesslprl ions shall non only 4' and the person for the lw survey a .r�.e. ASTAKE 0 SO" /ttel agency and lending institution listed :and j •f ,�, _M to the°Wrests of the lending institution Cartel., \"//{A tads are not trasfsdfN to additional Matte.* j ADJOINING SEPTIC d WELL LOCATIONS PROVIDED BY OWNER ��s T SURVEYOR ►II AREA = 101,1e16 5F OR 2.51 ACRES �1 ,, JOHN' , L` '�- ►J V It Y �iYOR 1 4\ - 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 GRAPHIC, SCALE 1"= 50' ` ce RIVERHF.AD,N.Y. 11901 1 369-8288 Fax 369-8287 REF.—\\Hp serverVAPROS\03-104.pro L 0