HomeMy WebLinkAboutNine, Robert (2) OOFFOL4'
ELIZABETH A.NEVILLE ;',=�0 G��•
. Town Hall, 53095 Main Road
TOWN CLERK y Z P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS p �It Southold, New York 11971
MARRIAGE OFFICER =y� ��of Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER _ Q( #010. 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. 3164 R Residential x Non-Residential
Fee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : ROBERT & JANIQUE NINE
Address 1: PO BOX 1401
City St Zip MATTITUCK NY 11952
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 #R10-03-0146
Name Of Owner NINE, ROBERT & JANIQUE
Mailing Address 1 PO BOX 1401
City St Zip MATTITUCK NY 11952
Property Address 1 855 NEW SUFFOLK AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 114.00 block 11 lot 22.001
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 4/15/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
,• /.,,O�OS�FFO��►co 3 ( (O-I
ELIZABETH A. NEVILLE �0 Gy�:% Town Hall, 53095 Main Road
TOWN CLERK t co ZP.O. Box 1179
REGISTRAR OF VITAL STATISTICS
t; Southold, New York 11971
O �
MARRIAGE OFFICER y Fax Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ;,:Q,� Agg -0 O. Telephone Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ �eg� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
APR 5 VS TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 5, 2004
Transmitted herewith is a copy of application No. 3301 for a Cesspool/Septic Tank
Construction Permit submitted by:
Robert & Janique Nine
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: /' �sr: .,,,dor, i'
���
Signature
Date
Aft
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"' ' • yes SUf F0(,t
ELIZABETH A.NEVILLE ;1 Dy\` Town Hall, 53095 Main Road
TOWN CLERK Ci P.O. Box 1179
V, Z $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS V.• 1
• - • MARRIAGE OFFICER . 14"1 Fax(631) 765-6145 _
RECORDS MANAGEMENT OFFICER =4••
a���il Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER 491 ilig *vll" 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 @ $25 Application No.
� Permit No.
Applicant Name `, EiT i Alr1
� c)u( J1\...) .1,,c_1�(
Applicant Mailing Address 10 g0X Hot
MIATTi.-Nucu, 1\J i \19 Sa
Septic Tank ,.' or Cesspool L.-
Brief Description of Proposed Construction or Alteration NEwCON 5T 121.1CT'.i , S1.AiGZE
L.LY cu 3ELLING-
Location of Proposed Construction/Alteration:
Owner of Property: (2-r + 3n(QTQuc Mi/v(
Owner Mailing Address: 90 kOc \LtO
'RT TL A(u , � \\I S
Owner Property Address: ASS N c(A) So r Fo i-K fi v E
M/Ai--V I ¶V C-k
Name and phone number of contact person 630 D9$ - 12-g)
Tax Map No: Section \N Block \\ Lot pD.1
Cross Street N A1>
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
rlf1.1 \a3\v`1
Q ,� Signature of Applicant Date
Received by: /aN"'�-'
,„ .....
OF •
1 1 ,vood brace ,
r "res ,TniucK ` �—
T &KSNYN
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SURVEYED 01-04-03W E
AMENDED 09-24-03,02-23-04 '
SUFFOLK COUNTY TAX* S
P/O 1000-114-II-22J
SUFFOLK COUNTY DEPT.OF HEALTH e
SERVICES REF. N111BER RIO-03-0146
ast1llfl9131)1+0: 13
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Raymond F.Nine . I$00..c'F°"`° .'
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SMOL cCcx COUNTY oar oFMAUR VICES
! T Ai.OECOMI 'RUCTIONI A ' Land Now or Formerly of:
antica PR oi�LY 1 mond F.Nine
1' SE* O9 00"E C/13060.
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09-18-03 o �
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1, 1
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1
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sP Nr. , . .LE rI 1
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176052 ' 1 g� O
el,23 ,c Ivy 1 ,
N86r0Oe11 10 ¢L30.. el.26
W ,
A writer n10k1 W
Cl. 5 edge o povemen
. q�® p�
a ®gk elAvenue
New Sen e
1:welling
well in rear
of house Dwelllnqq
150+ public wafer
NOTES 40f NEW).04.
IN MONUMENT FOUND 0 k.,. sop bola,*OdonOO bat wawa•••I in•"
o PIPE FOUND * rq • * Owaktn al •. :n`e'w'
%V _
TOTAL AREA = 20,622 S.F.OR 0.4134 ACRES `4 u\P![�S��J `��"�
t•Oa miaow*AI No Woad holablim ands.
a lbw so not oand*to•Oollosrei WO..
JOHN C. EHLERS LAND SURVEYOR
6 EAST MAIN STREET N.Y.S.LIC.NO.50202
- � RIVERHEAD,N.Y.11901
369-8288 Fax 369-8287 REF.\\Hp ec ve\d1PROS\03-202A.pao