HomeMy WebLinkAboutErickson, Christopher �SOFFOL j,
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ELIZABETH A.NEVILLE y� Town Hall,53095 Main Road
TOWN CLERK o P.O. Box 1179
REGISTRAR OF VITAL STATISTICS i Southold, New York 11971
Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER pl 4,0 Telephone Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER it 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. 3203 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : AMPLE CONTRACTING INC
Address 1: 675 HIGH STREET
City St Zip PORT JEFFERSON NY 11777
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 #R10-00-0096
Name of Owner ERICKSON, CHRISTOPHER
Mailing Address 1 PO BOX 782
City St Zip FARMINGVILLE NY 11738
Property Address 1 1250 WHITE EAGLE DRIVE
City St Zip LAUREL NY 11948
Tax Map No. section 127.00 block 9 lot 18.000
Cross Street RAILROAD DRIVE
Building Permit Number Cross Reference:
Issue Date: 9/02/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
IF
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ELIZABETH A. NEVILLE ���,_�� * Town Hall, 53095 Main Road
TOWN CLERK o • ; P.O. Box 1179
co = Southold New York 11971
REGISTRAR OF VITAL STATISTICS ‘Q �'�t
MARRIAGE OFFICER -..- jig Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ,'.�Q! �a��►���' Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER ,��� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
RECEIVED
JUL 9 200+1
TO: Southold Town Building Department AUG 2 6 2004
FROM: Linda J. Cooper, Southold Town Clerk's Office
Southold Town Clerk
DATED: July 9, 2004
Transmitted herewith is a copy of application No. 3344 for a Cesspool/Septic Tank Construction
Permit submitted by:
Ample Contracting Inc
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: :104.• ig.... - - - .e'_, -
1'
wr.d.e..z.r.„
Signature
-,2.3 ova V
Dated
''9'o�goFFOl,tco
'
ELIZABETH A.NEVILLE k Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ! y, �+ Southold, New York 11971
MARRIAGE OFFICER : �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = �� a�*•� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER _ * 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 No3 " t
Permit No.
Applicant Name , ���(-�\6\11C
Applicant Mailing Addr s � C L
7=7::\E K.) LA .1.11,71I'
Septic Tank,'or Cesspool
Brief Description of Proposenstruction Alte tion v J4*
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address: ' :) 11,(6
c=kc; , \LA \,\,9 ?..)
Owner Property Address: \'-S(:)
Name and phone number of contact person 1)\-\(c-
Tax
)\-\(Tax Map No: ‘CCX) Section z-7 Block Lot
Cross Street \ � .
NOTE: LOCATION MAP MUS BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SUR Y WITH HEALTH DEPARTME APPROVAL// Q
bli‘Sign e of Applicant ate
Received by: l
LOT AREA = 41.726 SQ. FT. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVI :.
FAR ELEV 17.5
F FL ELEV 19.5 PERMIT FOR APPROVAL OF CONSTRUCTION FOR
SINGLE FAMILY RESIDENCE ONLY
DATE 572—0 D HS • .NO.1a_t_O-00--G 6)
APPROVEn
i , .R L _- ►.... .( A
NOW & FORMERLY POR MAXIMUM OF, BEDR 0 OM
de
KENNETH LEEDSPER S 3T02.12 f EXPIRES*PZEYEARS FROM DATAPPROVAL
REX
no II,
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DANT
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(76.1) 220,93.
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Papal (77-3) `/.2 .e ar
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\.4 132.46' (75.8)
FD
R = 570.00' /
SU
_ L z (73,8)
9 t� 158.47'
(74.5) WHITE EAwGRRr mQ;nV ------LE DRIVE
(72.4) 4
w• c--:
DWELL PV@UC WATER z....-�_ w:.;
NOTE: LOCATION OF WATER MAINS ' '-,°
AND ADJOIN ERS WATER SUPPLY BY .,, W
OTHERS AND ARE NOT GUARANTEED. " 'i.`'
= .72-:'E:_,.
-..y
ti.ti �
1W OFFSETS (OR DIMENSIONS) SHOW HEREON FROM 1W STRUCTURES 10 THE IN?
PROPERTY UNFS ARE FOR A SPECIFIC PURPOSE MD USE AND THEREFORE ARE NOT JOB No. 04-231
INTENDED TCE
O GUIDE THE ERECTION OF FORS, Romeo WALLS. POOLS, PATIOS„ FILE No. GOLDEN : t
PLANTING AREAS. ADDITION TO BUILDINGS OR my OTHER CONSTRUCTION.
SURVEYED FOR CHRIS & RACH 2 "'
UNAUTHORIZED &ITRATION OR ADOW N to THIS SURVEY IS A VIOLATION OF SECTION LOT NUMBER 18
7200 OF THE NEN YORK STATE EDUCATION LAW.
MAP OF GOLDEN VIEW E ,,,"ti
GUARANTEES INDICATED HERON SHALL RUN ONLY 10 THE PERSON FOR WHOM THE
SURVEY IS PREPARED. AND ON HIS BEHALF TO THE TITLE COMPANY. DOVER ENT& SITUATED AT LAUREL
ASENCY AND LENDING INSRfU11ON Ui1kD HERM. NC TO THE ASSIGNEES OF THE
LENDING ILEmUna+• GWR4NTEES ARE NOT TRANSFERABLE TO ADOnIONV. NOTTRUTIONS TOWN OF SOUTHOLD, SU ,,.
OR $UBSEOUD4r EWERS.
COPIES OF DES SURVEY MM'NOT BEARING THE LAND SURVEYOR'S BIKED SEAL OR SCALE 1" = 50' DATE 6-15-2004
EMBOSSED SEAL MALL NOT SE CONSIDERED TD B A 11IL10 TALE COPY
FILED MAP No. 7770 DATE 8-30-1984 4
CERTIFIED ONLY TO: TAX MAP No. (REF ONLY) 1000-127-9-18 DISK .
HAROLD F. TRANCHON JR. P.C.
LAND SURVEYOR
P.O. BOX 616
/4-4-(ti F-r:A-6-, 1,- 9
1866 WADING RIMER—MANOR RD. WADING RIMER,
NEW YORK, 11792
N.Y. LIC. No. 048992 631-929-4695
ROLD F. TRANCHON JR. PENN. LIC. No. 2115-E