HomeMy WebLinkAboutEccles, Thomas (2) � t
,,,,,iii,,
ELIZABETH A.NEVILLE 04 OG'yd�, Town Hall, 53095 Main Road
TOWN CLERK o • P.O. Box 1179
H 2 ; Southold,New York 11971
REGISTRAR OF VITAL STATISTICS en 1
MARRIAGE OFFICER ,6 `,F,��� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ; �0" �a�ii' 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. 3227 R Residential X Non-Residential
Fee $ 10.00 Septic x cesspool
PERMIT ISSUED TO:
Name : THOMAS ECCLES
Address 1: 28 HARWOOD DRIVE EAST
City St Zip GLEN COVE NY 11542
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 #R10-02-0150
Name Of Owner ECCLES, THOMAS & BETTY LOU
Mailing Address 1 28 HARWOOD DRIVE EAST
City St Zip GLEN COVE NY 11542
Property Address 1 815 UHL LANE
City St Zip ORIENT NY 11957
Tax Map No. section 15.00 block 5 lot 24.008
Cross Street RYDER FARM ROAD
Building Permit Number Cross Reference:
Issue Date: 9/02/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•• (.0�FFO�,�-`;; 3 a a _7
ELIZABETH A. NEVILLE �� Gy�: Town Hall, 53095 Main Road
TOWN CLERK y = P.O. Box 1179
.a• i Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS Q ��
MARRIAGE OFFICER y �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ='49.( jig . "l� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �,I,. southoldtown.northfork.net
VOR 9 Z 9 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
RECEIVED
TO: Southold Town Building Department AUG 3 0 2004
FROM: Linda J. Cooper, Southold Town Clerk's Office
Southold Town Clerk
DATED: August 25, 2004
Transmitted herewith is a copy of application No. 3369 for a Cesspool/Septic Tank Construction
Permit submitted by:
Thomas & Betty Lou Eccles
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: .r110 ,
r / i
7°‘.. e,‘qta 41.
Signature
Dated
ELIZABETH A.NEVILLE 1,I,�`�`. O4�` Town Hall, 53095 Main Road
TOWN CLERK q , P.O. Box 1179
t ti Z 1 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �y. A� I
MARRIAGE OFFICER Fax O � '�� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = a0. el Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �0' * 1.1' southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10A or Non-Residential @$25 Application No. 3 3 ‘7
Permit No.
Applicant Name �, r .t _• _ -
Applicant Mailing Address 2 tsit 1/15 (
Ccve c N ?—
Septic
Septic Tank -or Cesspool v
Brief Description of Proposed Construction or Alteration N�t.A.) r (a s G
-sc [: Sy - (.3L) /WO.. .c t— l 2 `,4(8
Location of Proposed Construction/Alteration:
Owner of Property: S ,Qop a-tx'm
Owner Mailing Address: S trAmt /-% Jam,&
Owner Property Address: LOT- 10 6 8\5 v\L «}y e_
(9431-* y- ( k5 s -7
Name and phone number of contact person S "WLe' Sc-e L q 7 7 -1Y2-2-
Tax Map No: Section I S Block ® S Lot 2-*
Cross Street V )car P It)
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
1t1001. AIR/ g/2- G
Signature of Applicant D
Received by: � �t- _,
401E
1Ea aeRs/'/_l 06.70' / Lot 160
2.350• ..< Woods Une sere Wree f Map of Orient By The Sec�w
I �S, o
I � Section 3 {'
At Orient
Town of Southold j
Suffolk County, New York a
I
1 o Lot 160 N j
I o 1 Suffolk County Tax Map Dist 1000 Sect. 15 Block 05 Lot 24.8
U of
1 u EL.105.0
1. Wooded14
I o° b 1. AREA =41.064.87 SQ. FT. OR 0.94 ACRES
1 0 I 2. •= MONUMENT FOUND
o' 3. SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK
1f 1 OF SUFFOLK COUNTY ON OCTOBER 16.1974, AS
h (/ MAP NO. 6160
>°J I 4. ASSUMED DATUM
5. NO PUBLIC WATER WITHIN 500'
I 65'k
6. EL 99.0 = EXISTING SPOT ELEVATION
I E�'0 V e, 7. (99.0) PROPOSED SPOT ELEVATION
- N5
I
1 (103) u I i. 12.
Proposed Clearing (10.3) a 1iO
ski ) a _c a
V I 1 a '
---PLEASE NOTE
I zt.o
iwttnimusta
m dince between well
j¢ 1
a.n..
dcepodttsto:-be 150
feet.
.
r 1 ►Utility _25 0,
i , . Z,.0' it ,au ' •
. .o. .102.0 14.5' Q �s 49.5(025) i 1)e ,\1;\40.,\1;\40...dEXCAV INSPECTION
REQUIRED
__
N.
Frame
__ ) IFOR SANITARY SYSTEM •
w Residence $ 1 Existing BY HEALTH DEPARTMENTFirst Fr.
Elev.= 104.6E:
►m (Plotted From HEALTH DEPT. USE
g2zo' N ,zs' .oar(1026) —— 1 ad sarvey s) l
0.O i o -13
O (1025) A pool Over wood Porch
,r2,-„,,.,02...., I" C
3 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
— -
,
VIProposed ` \ / 121' t9oSanRan MAW FOR APPROVAL OFCONSTRUCT ION FOR A
sot. 0 ; _1 t t 6o m co Exlet n Wel p SINGLE FAMILY RESIDENCE ONLY
\ 0 • 3 a' BATE 19--6—O a HS REF.NO. R t0-0a-O(SO
// \. .; S, •
. 3 APPROVED
/ ; �•.. \ 5. O FOR MAXIMUM OF, MS
13 '
.,-3.
// \ .4. 1 EXPIRES THREE YEARS FROM DATE OF APPROVAL
o ? i0'0 \ .� \ ad
4.1
/ \ 'F(,,
k. / \/
,aa4�99.9111 SURVEYOR'S CERTIFICATION
.. W o°�
// 11'33yp•W E / WE HEREBY CERTIFY TO THOMAS FQ E3, BETTY
ia w�`oO j- LOU FOCI ES AND COIMiIONREALIH LAND 11A,E NS
COMPANY 000'11308) THAT THIS SURVEY WAS
may; y-' / / 0_99.6 PREPARED IN ACCORDANCE WITH THE CODE OF
r / PRACTICE FOR LAND SURVEYS ADOPTED 8Y THE NEW
ietin9
;2i -
YORK STATE ASSOAON OF LAND SURYORS.
_ / 0,,,
.7/ j 8 ol r
o
holt Pa
`psP ,i7vacont * fit *
•
'r • Ei-,p0 ./ cdettn9 //