HomeMy WebLinkAboutGonzalez, Jewell ELIZABETH A.NEVILLE _ ; Town Hall,53095 Main Road
TOWN CLERK k o • P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS � 1,7 Southold,New York 11971
MARRIAGE OFFICER ,f, t� � Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER "7Q1 �a� �i Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER ,080southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3172 R Residential x Non-Residential
Fee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : JEWELL GONZALEZ
Address 1: 1380 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 #R02-04-0675
Name of Owner GONZALEZ, JEWELL
Mailing Address 1 1380 WATERVIEW DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 1380 WATERVIEW DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 7 lot 25.000
Cross Street MAIN BAYVIEW ROAD
Building Permit Number Cross Reference:
Issue Date: 5/17/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE �� �� Dy
J.� all, 53095 Main Road
TOWN CLERK ; H Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` �► � Southold, New York 11971
MARRIAGE OFFICER ` #1.0* ����, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ��( jlig 4:00. Telephone Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER '= ,��� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
Nrrt 'L 12004 TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 3310 for a Cesspool/Septic Tank Construction
Permit submitted by:
Jewell Gonzalez
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:
'24.6e4(ag?ei.
Signature law".1.2
Da
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ELIZABETH A.NEVILLE 4 h` . Gy Town Hall, 53095 Main Road
TOWN CLERK k' O ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % 0. Southold, New York 11971
MARRIAGE OFFICER , 'W 1t Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `.y�� Aov•01 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - 4 � ,,�'t southoldtown.northfork.net
"..,..0,*
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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. 33/0
Permit No.
Applicant Name Si-Ace-Ay i3ITKdp a„ "BcKA,._,c oa �a.►,-2_4_ c,c,,,,ZA -Z
Applicant Mailing Address /.SD t,Jtvm,z✓i«✓ D/t - fuA-R-toL.-vQ
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration 1Jc-0 SiAx,cv" A./icy ')i.0c=c.4_,,,i6
70 ,Qi-PLA cc; &?(/J77.J L. b--riaoye:o Bye ' 'cam_
Location of Proposed Construction/Alteration:
Owner of Property: 3-+..)r-L_4- Gc A)244 cc-2—
Owner
Owner Mailing Address: /3eo 0 A Mx.Vic,.) Di(
SOLA-ii raLfJ
Owner Property Address: " SAAA c: -
Cm R- 64,j,vc 44,.../A.c+vc,3)
Name and phone number of contact person ...97)4 cxy 3 i,rN aro _7 los-6 -7/ 7
Tax Map No:/000 Section 7 ? Block 6 Lot 23"--
Cross Street /t1 „> -ZAVI//C.i,J nit
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
0//iW
Si e of pplicant Date
Received by: , 1A-Lt
1 Young & YoungAOif
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j ` k �L 1_ �' ' Q�v . Howard W. Young. Land Surveyor e
\�` q O^ �ffi �OP�`�4' Thomas C. Wolpert, Professionat Engineer is al
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c �7j v� �`� / RobertC. Tact, Architect 5
W E 5�,�6 %,„:q, o,,i Ott, /� �P1�p Ue., Ronald E. Pfuhl, Landscape Architect
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+ � ��� ��+t�, j �0�.< '' I 51� JEWELL Z. GONZA�LEZ !!h
Mp ii PALE BROM At Southold, Town of Southold ,.
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I FINE SAND
Suffolk County, New York IP:
I /-- . \ '17 '3`L 1+\� • !� / Q rurER 1N County Tax Map District 1000 section l8 Block.07 Lot 25. 1pS
q^ ^ ALE MOWN
/ D\ ('' NOTES PFItNE AND . i
o„ ..t • 0 UJ BUILDING PERMIT SURVEY I;
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i.- ��9,) Jj �> �� AREA = 16,587 50. FT. Iso• o
\ q�iq'Ci ^� 9< • VERTICAL DATUM = N.G.V.DATUM(M.S.L. 1929) ,
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AMENDED SANITARY SYSTEM FEB.25,2004 Kg
' J C'C v 40
p�g49 • OWNER STATES EXISTING SANITARY SYSTEM HAS BEEN ADDED TEST HOLE FEB.2,2004 iI
s;c c�`O REMOVED. MAP PREPARED NOV. II,2008 ;1.1
` s • OWNER STATES THAT EXISTING WELL IS DEEPER THAN , , 7
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\ try 40'.
FIRM FLOOD INSURANCE RATE MAP PANEL NO. SCALE` I•=80' e#c
j.MONUMENT SET ■•MONUMENT POUND A:STAKE SET ♦.STNce roup O.PIPE rc 36105COI6t' G LAST DATED MAY 4, 1998. NO.2008-0495 '�� - 3
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