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HomeMy WebLinkAboutClejan, Marc � � � �oSUFFoc,��o ELIZABETH A.NEVILLE o�O G'y� Town Hall, 53095 Main Road TOWN CLERK y P.O. Box 1179 REGISTRAR OF VITAL STATISTICS � �' Southold, New York 11971 MARRIAGE OFFICER �j,►f. � �� Fax(631) 765-6145 RECOftDS MANAGEMENT OFFICER _7�,( � .��� Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION Oit RLsERATIflN PERMIT SEPTIC TANK or CESSPOOL P2rmit No. 3165 R Residential x Non-Residential �ee $ 10.00 Septic x Cesspool "�RMIT ISSUED 70: haa.(1�2 : ROBERT SCtiEIDET �?ddC255 1: 560 WATER TERRACE City St Zip SOUTHOLD NY 11971 �escripton of Proposed Construction or Alteration SANITARY SYSTEM FOR ONE FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFO�K CO�NTY DEPARTMENT QF HEALTH SERVICES. REF #R10-03-0129 �.am� Of awner MARC CLE7AN ------------------------------ rEa�ling Address 1 C/0 PAT MOORE ------------------------------ 51020 MAIN ROAD ------------------------------ City St Z1p SOUTHOLD NY 11971 -------------------- -- ---------- Property Address 1 2570 CLEARWATER AVENUE ------------------------------ ------------------------------ i:ity St Zlp SOUTHOLD NY 11971 -------------------- -- ---------- 7ax Map No. section 70.00 block 10 lot 29.002 ------ --- ------ Cross Street GAGENS LANDING ROAD ------------------------------ suilding Permit Number Cross Reference: ---------------------------------- zssue �ate: 4/15/04 Elizabeth A. Neville -------- Southold Town clerk (TOWN SEAL) � _ _ _ . _ _ � �osoFFoc,��o 3 t �c ELIZABETH A. NEVILLE � Gy� Town Hall, 53095 Main Road TOWN CLERK y P.O. Box 1179 REGISTRAR OF VITAL STATISTICS � � Southold, New York 11971 MARRIAGE OFFICER � � O�� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER ��,( .�� Telephone (631) 765-1800 FREEDOM OF INFORM�,TIBP�Q,FFICER � southoldtown.northfork.net _--_ ;. , 3� OFFICE OF THE TOWN CLERK � TOWN OF SOUTHOLD 1 '�O: � Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: April 12, 2004 Transmitted herewith is a copy of application No. 3302 for a Cesspool/Septic Tank Construction Permit submitted by: Robert Scheidet 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 ��� �y �� Dated . ' � O��S�Ff���'CO ELIZABETH A.NEVILLE �`Z` G•y� Town Hall, b3095 Main Road TOWN CLERK p . P.O. Box 1179 y �e Southold, New York 11971 REGISTRAR OF VITAL STATISTICS v. A1 MAR.RIAGE OFFICER O � � Fax (631) 765-6145 RECOR,DS MANAGEMENT OFFICER y�f 0� Telephone (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 PERMI7' CESSPOOL or SEPTIC TANK Residential @ $10 or Non-Residential @ $25 Application No.� Permit No. Applicant Name %� n f�-C2 f �� h��C'Q-� Applicant Mailing Address ��� ?� Gf/c�,�c... 7--r�,�icz-e�- �S�4z�G 6 /c� � //�l 7 r Septic Tank or Cesspool /� / Brief Description of Proposed Construction or Alteration K-� �c,f���yu-- Location of Proposed Construction/Alteration: Owner of Property: �-� C .-e � — -Ge,c-� ��P�� �/�,n�� Owner Mailing Address: � /�f/�,.�., �".P�n��� c1Gnu�o �����a c� S 6 � Owner Property Address: �1��"�- C���a'j^ �/b Cc��-� �>���``� �d Zb /�a-r.t; i�-� S a/a� �`'`� /� 17� � Name and phone number of contact person Tax Map No: Section �G Block �� Lot � � � Cross Street NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITF� ALTH DEPARTMENT APPROVAL y�Z -�y Signa ure of Applicant Date Received by: , _--._______._._-_.�._.___ -- - �_ --- — --------------__� � "'�`� , TEST HOLE DATA ; y CrFsr r+«c ouc e�- oN,�E ,s. 2ooa) p SURVEY OF PROPERTY ! � � O�`� °",°`�'°""''�"''°` SITtIA TED AT � � a � -,:,`,`:. �'`��.r�� PINE NECK TOWN OF SOUTHOLD � �� �" °"`E�'"""""°�"`S"°�' S U FFO LK C OU NTY, N EW Y 0 R K � X � �ecuNc , � °-� S.C. TAX No. 1Q00-70-10-29.2 � SCALE 1"=50' �:.� • tSi � �' � ' -� `� � JUNE 13, 2000 � �.,�+ A j���r � _ � 't ,� v�o.,� � w�,t���� nucusT ze. 2000 ,�aeo rRoavseo tiovs� at ti j ro oa�esc avo ew E � �7--� (�-) (� o SEPTEMBER 28. 2000 R£VISED PROP. �PTiC SYSTEM J 1��/ N• � [fj Z pq�p�y� OCT08EFi 1. 2000 �DED LDT G1pVERAGE NOTC �T OT .t..s,! .?� L.l.f Y � '- D � "� � , /�;_ NOVEAf6ER 1, 2000 REVISED F�LOT PLAN � a" •. .-� Z z y � � �Y ���?" QECEMHER 8� T�0 REWSED PATH i ,UWlIA.4Y 28, 2001 I.,OCJiTEp 1E�7 1VEl(. , _ ...{ tI� O "� � , MRIL 25, 2d01 REYISED SEPTIC SYSTDd AS PER F. S. KEfTH, P.E. � f °�'�) . ` � Q A F�]i�i �a b �'_ y � tN r,a�r� a�, 2oai REVtS� SfiE PIAN s at.�'�� ______ ' $ t�Q&'30"� � � + -�p �{ � :�ar��n : � ��' AREA = 29,687.55 aq. ft. �.av' '' �x o L�' Cro nE ur+E} 0.682 ac. +s'� "�`i�! z _�, �� I ,� � Cl � �z b� �'b ►nu° -.�'� Z ��p� _ , �__"�' C��'IE� PO: �' - _ � c�wc.,�,. '- Z 2' - '� t _ �' ,'� �q,C1 '=3 C/8 �� � , = PECONIC ABSTRACT, Inc. � o,.__._ '\'�" � -,o� i = o FtDELITY NATIONAL TITLE INSURANCE COMPANY OF NEW YORK � � � + � �; �. � ;� � -�%�� r 1 _ . �; ANF1A Ck.E.IAN C'b � - - --�� � �i�� r�1 +g �� j � �t: , �'� � ~€ .j �, :' . .. ' a O��:', �� Q � ;, �. � � � � 14 � (Ji . � - � i ��� i. ELfVA710MS ARE �EM�D TO N.6.V.D. 1f29 DARN�1 M � ya �j � 1: 'x ,6 O ��� rb � ( � t EXISTMiG COItTOu�SUkES SfWWN TtiiR. .. .. _6. . .. - � ��rq v s� F � �\ �j �--------�-�-- .� raoposco consous uH€s ►� saa�w+ n+us: �-- �t� � �t, � � .'� /�� B x � J �' _ �: �L.M:ATI�M FOR EXPMl�Ok OF �LEACFNIG POOL G.APACRY. ^�'� � � � -� � �� COIiC- YIOH, � � � � � � j t!'`1'�f �� L� CES�DOIS AS PHi IXISTMIG WElI� � � 2�OP.EF,�M7 H f'LAi �R. (S��N6 POOL ARIG N��� �� . � � O SURvEY 8Y 1qM1 Tl/Yl `� � , f �1 �PRorosco �00o culAN rwEGsr�re sErrlC Tuwc � � � � � ,' �. 5 �* ON �6. 19>3 ,���'�t/2%" �^-': .Ss-"GA�G� 2. Tt� tACATWW OF WELLS A!O GESSPOOLS SHaiM iffREON ARE fROM FlEID � �,� �, . �� . --� 0 �/ 08�RVATW1r5 M�/�2 DA7A �fA1MED FROM DTNfRS. �E e" , ry �� , . wor�-r+�rn.wa�►+o�+a►s. �- WO /" r,� ��� 3. THtS PROPERTY IS IH FLO� Z61� AE (EL 8) AS SNOWN 0t1 � "�i'f � �o � � � ���x�VMht�S�f�tJ�Cti�1.� '� FLOOD klSURAlICf RATE MAP COIWUNITY-PANfI No. 36703C0166G � � x � �"'� ���.�. 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Ingegno ,�� � �/ //- r3 SEWAGE DI�POSAL SYSTEM BY: �°'������m Lan �U�VG�/�!' �`"''�"�'w,',,� � ,�'- SAG HAR80R ENGIMEERING �«,�•���� �+ '�r -..`` � ��� 381 Town Line Rec�d, St3+� Narbor, New York �`Y�������` �V ��. N 71itE�4AU'Mltt iM.�AtTicY sNo Rt(e Surneys - SubdJvirions - Site Plons - Conatruction layvut ' 3 • „ o Frsclericic S. Ka'tth, �'.E. �+�r�pn � 2 t$ io"� �,�N�or�fl��toN+c�sn- G(� (V � � nma�.��wE Ner'r�aw�aei.E. PHONE (631)727-2090 Fax (631)727-1727 �y a� Ov� ���„J'� BS,17• � ��CA� NIS�iEN �r�. IF OFf7CE5 LOAl7ED A7 MUIING AD01�SS � ��#�/,� p@� �. 1 J 8 0 R O A I i O K E A Y E M 1 E P.O. B ox 1 9 3 1 RMERFiEAD. Nex York t i�i fiwerh�od. tisrr Yaric 11901-OS85 ,