HomeMy WebLinkAboutAnemoyanis, Vivian (2) A a
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ELIZABETH A.NEVILLE ;= G'f�; Town Hall, 53095 Main Road
TOWN CLERK % o - P.O. Box 1179
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; Southold New York 11971
REGISTRAR OF VITAL STATISTICS nY '
MARRIAGE OFFICER
‘94f_ � �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER :_ Ql �a���� 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. 3228 R Residential x Non-Residential
Fee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : VIVIAN ANEMOYANIS
Address 1: 645 HICKORY AVENUE
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 #R10-04-0060
Name of Owner ANEMOYANIS, VIVIAN
Mailing Address 1 645 HICKORY AVENUE
City St Zip SOUTHOLD NY 11971
Property Address 1 2960 LIGHTHOUSE ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 50.00 block 4 lot 2.002
Cross Street SOUNDVIEW AVENUE EXT
Building Permit Number Cross Reference:
Issue Date: 9/02/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZAW3TH A. NEVILLE � Town Hall, 53095 Main Road
TOWN CLERK y i P.O. Box 1179
v� Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS . Q 11
MARRIAGE OFFICER y �/ Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER -:49/ .. ii Telephone (631) 765-1800
F''REEDOM OF INFORMATION•OFFICER '-. ,,,•��� southoldtown.northfork.net
ailOFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 31, 2004
Transmitted herewith is a copy of application No. 3370 for a Cesspool/Septic Tank Construction
Permit submitted by:
Vivian Anemoyanis
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: ,t.it...,V
77.140.2479/
•
Signature
Dated
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As�FFot,�e;
ELIZABETH A.NEVILLE ,�s��O �4; Town Hall, 53095 Main Road
TOWN CLERK ;' 2 . 1 P.O. Box 1179
VI at
REGISTRAR OF VITAL STATISTICS ‘`.°O,4,_
�$ Southold, New York 11971
MARRIAGE OFFICER : '� 1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER \--TO a��'1°1 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ---__-
:1 Mg 1,a'o 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 3 70
Permit No.
Applicant Name `.:,I 1 V 1 0 VI _fi 'L-) 1') 0 of 1/t 1' 5
Applicant Mailing dress ! i C k0 t/
f
Septic Tank ✓ or Cesspo
Brief Desc 'ption of oposed Construction or Alteration Ah)OIL / 16 cf 1A ,
Location of Proposed Con truction/Alteration:
Owner of Property: ; V i G 4fi 14 t rv1[1 ,( 11 1 S
Owner Mailing Address: 4 y s /-11/ 'L D fp 2/__Iz__
c'ivt �i 1>/� /11, ,i-7 ( g ? /
Owner Property Address: 2 g (p C t? >1,2I s-t_ 1
C WI ") it)6_ II
Name and phone number of contact person
Tax Map No:/Q-0 Q Section J 0 Block )'' Lot D,, 'Z
Cross Street ,/ ilinf ...Q ;pd -i _c/upe fP/lot, 4jj . ?,�6.3 5�
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SUR :Y WITH HEALTH DEPARTMENT APPROVAL
signature of Appli t Date
Received by: _ (..elt.L.__
GRADING PLAN SCDHS Ref.# R10-04-0060
SURVEY OF PROPERTY
4' APPROVED
F.F.EL 66' PPEAT SOUTHOLD
xx>< "^ '"°°<'==E^=',=• TOWN OF SOUTHOLD
LE _
"' LE °"- 'f �� SUFFOLK COUNTY, N.Y
61.2' too 60.r 60.3' is
' '6 POO. i 1000-50-04-22
PROPOSED SEPTIC SYSTEM SCALE: 1'=40'
, -SEL. 42• APRIL 6, 2004
[1]LEACHING POOL 12'DEEP WITH 3' CLEAN 6'aAUEITa N/OA- May 4, 2004
SAND COLLAR. REMOVE MATERIAL DOWN
TO SAND SP AND BACKf1LL WITH CLEAN SAND. &G¢ sou" Voir A ' T�\IP r E-QQ J Ay,• u Aug. 9, 2004 (addit/onsJ
(1] 1,000 GALLON SEPTIC TANK. 'EL. 24' ,r ��\aG� �i �i S74 3� "Ezt "ELL
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�iNG1i1►AMlGY €ZOmaY `�2 ��Q t � tiO� c,..r�:... cls r"'
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11\ * Off=COUNTY OSOANDENYOFNIALINSERVICES •
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d)A!� `Tl f1SR�1: —���CY�.3J t3.,....70_,.
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IAPPROVED c."........ �R . C'/ �ti + hl 16G.
t+qR oR .r kP J e \Ru „, 4iZo o Ivo
LXPtRESi Y811k� tDATE CFAr OVAL �„�r �•Q ,_- V' aP�� 125
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1 am familiar with the STANDARDS FOR APPROVAL
c_ ,-(....3
. \ i a -n'3
AND CONSTRUCTION OF SUBSURFACE SEWAGE Jc. 6° `,) - C:2 cc�,•`
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES S N �cm n
and will abide by the conditions set forth therein and on the a"
permit to construct. TESTHOLE DATA OF NEra c =�
The location of wells and cesspools shown hereon are EL 65 4/12/04 BROw pAYEr sAno sr `\' ' 1. °IP
ME 7.
4, from field observations and or from data obtained from others. ,a Fi
EL stj.----6.7•II O jt_
Elevations referenced to an assumed datum. �� * .d,rj 1a
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION �� yc ,'� cr
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. WATER IN BROW LYArEr SANG Nin+` i�
EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS GRAwL rro urERs sc 's .t r,� '•'.,;; Y.S. LIC. NO. 49618
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF (Per i- �` . Ili 17s=):''iRS, P.C.
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 631 • 0 FAX 631 765-1797
WHOSE SIGNATURE APPEARS HEREON. sr' P.O.)BOX 909 i )
•=PIPE NITER Ni PALE MOWS FP( ro MEauU SAND SP 1230
AREA=31.518 SQ. FT. 47 SOUTHOLD, N.TRAVELER STREET 91 1047-144