HomeMy WebLinkAboutCannone, Ignatious OS�ffOLA'
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ELIZABETH A.NEVILLE 1'= 1 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 Fax� �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ;,_ 1 �a�iii Fax
(631) 765-1800
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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. 3204 R Residential X Non-Residential
Fee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : IGNATIOUS CANNONE
Address 1: PO BOX 634
City St Zip SHOREHAM NY 11786
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 #R10-03-0161
Name Of Owner CANNONE, IGNATIOUS
Mailing Address 1 PO BOX 634
City St Zip SHOREHAM NY 11786
Property Address 1 4205 BREAKWATER ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 106.00 block 3 lot 6.000
Cross Street EAST ROAD
Building Permit Number Cross Reference:
Issue Date: 9/02/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE �+���� G'y� Town Hall,53095 Main Road
TOWN CLERK % o • % P.O. Box 1179
t H Z $Vs
REGISTRAR.OF VITAL STATISTICS k i Southold, New York 11971
MARRIAGE OFFICER `„�4, ).01 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ;__�Q! �a�/�� Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER _ Jig ,�'� Telephone
OFFICE OF THE TOWN CLERK
JUL 9Ste TOWN OF SOUTHOLD RECEIVED
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. 3345 for a Cesspool/Septic Tank Construction
Permit submitted by:
I. Cannone
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: 4..e.r.. ..a..........e .....
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Signature
ae-0#44--e- 7 .2-10e e,
Dated
ELIZABETH A.NEVILLE 0��`Z 4 \ Town Hall, 53095 Main Road
"` TOWN CLERK ; 2 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ; by Southold, New York 11971
MARRIAGE OFFICER : O t 0 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER .-5, a0. 01 - Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER '1 �'••�� southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
C.otc-X.-
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 L/ or Non-Residential @$25 Application No. �S
Permit No.
Owner Name I r\-- L`1O'SD `_--,. C_O\1\m \1
Owner Mailing Address— lc b' -\
2
Owner Property Address -V3. T\ `4'
vk-4v\--oc:x__, rw)U \\C<c .1
Owner Telephone No. 1 dts ---1\-F›• .1-94 - l"--1C-.k7-
Tax
-1C 7Tax Map No: Section \ ..v Block C:b Lot DL.4,
Cross Street , c N ,a, ---2_ci
Please check each that applies: New Construction
Alteration to Existing System
Residential Non-Residential
NOTE: LOCATION MAP MUST--BE-SUBMITTED WITH APPLICATION. (Locate
building and system; give north 'ow and approxiluate distance in feet from system to building .
and closest road. New constru ion may submit cop),of survey with SCHD approval.)
1
i'"\)--- ..7.X1. i
Signature of Applicant Date
Received by:
/
/ SITE AREA = 15,821.77 sq. ft. = 0.363 ac.
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I LOT 106 I �f �"�\ c()
^INRESIDENTIAL DWELLING I � 0� �i �/
c'.
PUBLIC WATER 3 r L , \ VI Fri \L cq
-1 r` 4s)02.2224: E x STOCKADE F r ° ••0 z ,GE re # 1_
o X°__a_ o� m X
- O HEDGE -0-�.._ rK� 151 12' �00 X �' - P4 •
0 •
0 M
Ill H
O 2.5' DIA
EXISTING SHE. O TREE EXISTING SANITARY ` .,yam`" Z F� d Z
TO BE I _ 32'-.004"0/030.1 SYSTEM TO BE _
I DEMOLISHED ABANDONED PER
PROPOSED SGDHS STANDARDS O L
I ASPHALT EXISTING U1 d�
1 EXISTING ONE I411 I
rn I WELL 0 N
J STORY HOUSE TO BE ► /100 rn93°
u� PROPOSED TWO r MM• ('(�
O DEMOLISHED ti, y O h1
p STORY FRAME rn
I-- I ry0 �\ House v 11 �� Abandon ent of existing sanitary system
(4 BEDROOM) _I to be witnessed by Health Department
–I Z I b 2.5' DIA 4,, 1 F.F.=IQ�1.5 Cii .
W , LOT 107 AGED OAK N),� \ G.F.=IQ0.5 42'_c1"07 3 N I ~
rn
rz 61'-7" \ O GROUND LEVEL
\ ` 2.0' DIA '0 /7
TREE -1 15' LOAM '
Lig 2.0 DIA .. O
AGED OAK - O z \ C9 — — —
OI p I ,�0 O
T O I p U / 5.0' CLAY
in PROPOSED SEPTIC SYSTEM m 01 03�Q� N Q
m USE 1000 GAL. SEPTIC 1 i -< O w TEST _ v O
0 TANK AND (I) 8' DIA.x12' -.\ 5�� �L� HOLE 0' DIA
Z DEEP LEACHING RINGS 'P
f �\ 10' Q � TREE
EXCAVATION
SANITARYINSPECTION
SYSTEM REQUIRED Q O
- 1.5' DIA I m \ MIN, g \.13
CYPRESS J L / S BY HEALTH DEPARTMENT L .- o z
FUTURE 50 10.5' W O
A. �( 60 +�� �" �.�� .5' DIA ,pd, SAND AND GRAVEL n/ In /- I
MA N 66°00'30i, W .J)Sf'ANSION \ TREE� ' / W Z
IL°9T C ROW 01-BUS \ — -O
BOXES t tE5 I--� ►—I Z0 C\ i
'.`'SIGN 131.37'
DGE OF PAVEMENTR=25.00 ABOVE GROUNDWATER a Z '� O
\ L=43.18' Z O f_- O
EAST ROAD EXlSTWG � SUFFOUNTY DEPARTMENT OF HEALTH SERVICE v CI
..
ITER MAIN (] �O
PERMIT FOR APPROVAL OF CONSTRUCTION FORA SITE PLAN BASED
N N N FAMILY RESIDENCE ONLY ON SURVEY BY: F: IL
TI PL A `DATE, ;GyLE
F• / JOSEPH A. I NGEGNO >Z
APPROVED �fjf =� LAND SURVEYOR O ' O
i 1380 ROANOKE AVENUE fY W
20 10 0 20 40 SO 80 100 FO MAXIMUM OF. : DROOMS P.O. BOX 1131 Q-
RIVERHEAD, NY 11101
GRAPHIC SCALE I" = 20'-0" RS FROM DATE OF APPROVAL
_�_ EXPIRES TI;fltl�YE�►\ TEL.: (63I) 72-f-2010 O
- --. _ FAX: (631) 727-1727
—
RESIDENTIAL DWELLING _ _ —
PUBLIG WATER - - - - - _
M 15C_JOBS/2003_JOBS/030033
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