HomeMy WebLinkAboutBrady, John osuFFo,,=�;
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ELIZABETH A.NEVILLE ,���S y Town Hall, 53095 Main Road
TOWN CLERK O P.O. Box 1179
y = Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER Fax 0?, � � Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ';�Q 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. 3234 R Residential x Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOHN BRADY
Address 1: 119 DICKMAN STREET
City St Zip BRENTWOOD NY 11717
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 #R10-04-0087
Name Of Owner BRADY, JOHN
Mailing Address 1 119 DICKMAN STREET
City St Zip BRENTWOOD NY 11717
Property Address 1 440 SHIPYARD LANE
City St Zip EAST MARION NY 11939
Tax Map No. section 35.00 block 8 lot 5.007
Cross Street MARINA LANE
Building Permit Number Cross Reference:
Issue Date: 10/01/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE t h� V Town Hall, 53095 Main Road
'TOWN CLERK ; 2 Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
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MARRIAGE OFFICER �: 4, N*01 Fax(631) 765-6145
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RECORDS MANAGEMENT OFFICER ---.79.1 „
� ,'�� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER ,.��� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
.2, -D 2 1 2004
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 20, 2004
Transmitted herewith is a copy of application No. 3376 for a Cesspool/Septic Tank Construction
Permit submitted by:
John & Emily Brady
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 pennit.
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: � .4.2...2. 41 \
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RECEIVED Signature
..A/epr,,,.., 2 __
, Dated
$s,F,,a—,9 Twh Clerk
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ELIZA, A.NEVILLE i h`Z` 4 \ Town Hall, 53095 Main Road
T CLERK i § IP.O. Box 1179
at Southold New York 11971
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REGISTRAR OF VITAL STATISTICS ` li '
MARRIAGE OFFICER %, G 1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER y4 •',�� Telephone (631) 765-1800
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FREEDOM OF INFORMATION OFFICER � �►a�'Ii southoldtown.northfork.net
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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. 33 7 C
Permit No.
Applicant Name j8/iN.z 1---/17/.I-, J6)/1/90/
Applicant Mailing Address 1/7 B i c i-r��9r✓�/tc)8C/?Onoon° IV,' //7/7
Septic Tank ! —or Cesspool -
Brief Description of Proposed Construction or Alteration ki�(-.v S) R)O L E F fiM I LI 7 t 111 tiG
f)'i, ) .S('I°Tc 7',942/T
Location of Proposed Construction/Alteration:
Owner of Property: ,70/,' tY.-s F/77)/...y A lg.) ) y
Owner Mailing Address:0 Qj DIc nr 2/9 n/STiBRPpJT 'o OD Ny /1 7/ 7
Owner Property Address: q q o N' P yA R p A tl - e"-(15r iii(1 R/eiN
Name and phone number of contact person / 3- 8 JC6(o
Tax Map No: Section( Block Lot 7
Cross Street,pHI1° Y/?R)0 nii9R1/11 A L t9it'e
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
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1 ) (./(},d2... ,'. gna a of Applicant / Date
Received by: L.
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SURVEY OF PROPERTY
AT EAST MAN
+ 0
TOWN OF SOUTHOLD
, - --4,.,<,_2�, SUFFOLK COUNTY, N.Y.
�P, �l • . .: 4 1000-35-08-5.7
G $ �, 'z '„ SCALE: 1'=40'
p��'\s3 Ch1' 4a .cp SEPTEMBER 17, 2003
Vile? G May 19, 2004 (BOHJ
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES ? ��
tax
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PERMIT MI;APPROVAL OF CON:11UC ION FOR A T' 3 e-, . !V
GIF FAMILY'R:-SI:2L•"NCL ONLY 4+ + ��
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DATE. �I I Dg "i2F No." ,` 7 OR_ .0APPRO nL. _.�r' �'L s, , ..2.00 �A
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FOR MAXIMUM OF,./_BER s S G� '°t,* p GO ti
EXPIRESSEE YEARS FROM DATE OF APPROVAL O k -
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�i ��/eco � ,�p1' '0 *c)
/ am familiar with the STANDARDS FOR APPROVAL
AND CONSTRUCTION OF SUBSURFACE SEWAGE ho•o �•,`�0 g� �P
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DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES 0 S-' �) PY'
and will abide by the conditions set forth therein and on the �oR►T's LQJ G�
permit to construct. v, e Q\O'
The location of wells and cesspools shown hereon are Q�`
from field observations and or from data obtained from others. `,G� ,�EOFNEWy
ANY ALTERA770N OR ADD/77ON TO THIS SURVEY IS A VIOLA 770N ,GV'� y���t MBTZC�f
OF SECTION 7209 OF THE NEW YORK STATE EDUCA7JON LAW. 'I+�
EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CER77FICA77ONS * ,,,,.ia6
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF ''r' _ /s - wag. N.Y.S. LIC. NO. 49618
SAID MAP OR COPIES BEAR 7HE IMPRESSED SEAL OF THE SURVEYOR 4 `ra '+ .RS, P.C.
WHOSE SIGNATURE APPEARS HEREON. LOT NUMBERS REFER TO "MAP OF SUMMIT ESTATES 1T , ,, M1 s, = r r FAX (631) 765-1797
ELEVA77ONS REFERENCED TO AN ASSUMED DATUM. EAST MARION, SECTION ONE'S FILED IN INE SUFFOLK
AREA=-30,000 SQ. FT. A=STAKE COUNTY CLERK'S OFFICE-ON NOVEMBER 22, 1993 '•°1' ,-
AS FILE NO. 9426. 1 ' is, ER STREET
SOUTHOLD, N.Y 11971 103-240