HomeMy WebLinkAboutWhite, Robert (2) •
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ELIZABETH A.NEVILLE = %.*". Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
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REGISTRAR.OF VITAL STATISTICS � � iv, � Southold,New York 11971
V 0 Fax(631) 765-6145
MARRIAGE OFFICER ,�► �1
RECORDS MANAGEMENT OFFICER 4b iii 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. 3201 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : STACEY BISHOP
Address 1: 150 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 #R10-03-0116
Name Of Owner WHITE, ROBERT & LEONA
Mailing Address 1 2200 HARBOR LANE
City St Zip CUTCHOGUE NY 11935
Property Address 1 2290 HARBOR LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 103.00 block 1 lot 28.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
wssue Date: 9/02/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE � � y�•
Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS � � �
Southold, New York 11971
MARRIAGE OFFICER `� � I� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ;y_�Ol �aON'.0
Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER . ��'� southoldtown.northfork.net
L OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 1, 2004 "' r'
Transmitted herewith is a copy of application No. 3342 for a Cesspool/Septic Tank Construction
Permit submitted by:
Stacey Bishop for Robert & Leona White
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 �� Q
Comments:
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/71/44.-4491.
Signature
a-4,4..A.P°907-7
Dated
C4,
ELIZABETH A.NEVILLE 1 h`1` Gy Town Hall, 53095 Main Road
TOWN CLERK % g P.O. Box 1179
REGISTRAR OF VITAL STATISTICS vy Southold,New York 11971
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = �� a� ��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER = '� •�i41," 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. 3 - U
Permit No.
Applicant Name c�Accor 2 Nates — ?i-c.) 3 c:Z..1- A4ANa 6,�if.._
Applicant Mailing Address /Sb cJA���v�N ) (��. So.4-1140(-o NY /197/
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration Nc i) SI/s � M
-- A «y
Location of Proposed Construction/Alteration:
Owner of Property: /6/3e t-r 1_c 0,✓ia GJt rtes-
Owner Mailing Address: �ac0 A1.
CLc7 t-N 0 tic-
Owner Property Address: . °2at(�
ff/t/(40,e_ Air.
Ci-iTCAO 6u(,7—
Name and phone number of contact person c-r cf.-y is•Hop 76,5-6717
Tax Map No: Section /0 3 Block / Lot 02k
Cross Street M ok i ni ter).
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
/l°Y
Si a e of Applicant Date
Received by: _ ,
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,, SURVEY OF PROPERTY 0 3— Q 1 ( C SII
SITUATE: GUTCHO&UE • '
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TOF 1N: 5011-101-1") ��;\\,h� 5 W s E
SUFFOLK COUNTY, NY N N
SURVEYED 01-II-02 m VAGPNT
AMENDED 08-II-03, 02-25-04 S
SUFFOLK COUNTY TAX # SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES vaGP,uT
1000-103-I-28 .
coopoococcoopoccoce
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
CERiu w o. 1GLE FAMILY RESIDENCE ONLY °--�
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LONA WHITE Rto,O3-O t I
DATE `�—L 1—O3 HS REF.NO. 1
i ' WELLING
APPROVED i Land nor,off: 51 ,,au Well •''''front
FOR MAXIMUM OF_ *ROOMSRol2e�i�rlhtte r,ptsr c>pet iG
5epttc 0 O HOLE
TEST
EXPIRES THREE YEARS FROM DATE OF APPROVAL
Elev. lel
7-------� � —� f \ l U O
Rte--�� —eZ�—014-
I Oyyetl dark
- loam
15'
I EL-16 light
0 ' % loan
1\\__________\ x 25'
yePttc I I I 1 '�' EL=j1 �1 0 VAGpNT
0 CD 0"`N - Q 10 coarse
I r f o co , O 4 sand
EL-1G r. C�Op - D ro of 4,-,Jos Is .w 3 — '4'
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i� a 1 r
r______I L. to --T
ccw C
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Hole O d VI 0 medium
Hovof
Sand
r. 5EAG0�`L Well
rmfl ar Q CD-1
W��6V_--- ti pyTELLING 12'
Q3 a • ►� f-°a 249 h N 0
..'a :: \,r 1 septtG
(4-.%° $ 19 maceo5E r) I.+.. a U fl- I7RNEWA (110sand
t se15' 1 \ Iles
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1 , 16 . - E =1
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GROUND
a4a5 u"° WATER
,�� t 14000
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_ - .tel ms
EL=1� 86 woo-,l0"" O y I1 In front
Welt
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in rear
0,4 or Formerly of septic 0 (n
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NOTES: ` '° .,
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V AGAr1T O Of/
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• MONUMENT FOUND septic unwmarized alteration or oddltbn to a survey LAND
nap Fearing a IKensed land surveyor's Seal Is a ,
violation of sectio,'1109,sub-division 2,of the -
0 PIPE FOUND NOM York State Education Lore
'Only copies from the orlgYal of this survey
ked,r1M an algYnl of the land surveyor's
AREA = 14 scarped zeal,,,all b'
carsN.r.d to�\ lid tr,,.
p00 S.F. OR 032 ACRE .00�, JOHN C. EHLERS LAND SURVEYOR
•GertifKatiwa h ddra sey:12 f Nis
7t1Te r�.ade r far Land Sways adopted 6
��e w..York State,la�oabtbn�f}ofessloral EAST MAIN STREET N.Y.S.LIC.NO.50202
GRAPHIC SCALE 1"= 40' f�^ shall
RIVERHEAD N.Y. 11901
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