HomeMy WebLinkAboutHolzer, Robert ,O�OCOMA'
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ELIZABETH A. NEVILLE e y� Town Hall, 53095 Main Road
TOWN CLERK y 2 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O Southold, New York 11971
MARRIAGE OFFICER � y 0l1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER - 01 * j ,. Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �'�v - ••is' 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. 3238 R Residential X Non-Residential
Fee $ 100.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : E. E. CONSTRUCTION SVS INC.
Address 1: 150 WATERVIEW DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
NOW SINGLE FAMILY RESIDENCE
FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUTNY HEALTH DEPARTMENT
Name Of Owner HOLZER, ROBERT
Mailing Address 1 14 SOUTH ST-SOUTHWOODS UNIT 4
City St Zip DANBURY CT 6810
Property Address 1 3385 MINNEHAHA BLVD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 100.00 block 87 lot 1.001
Cross Street OWAISSA AVE
Building Permit Number Cross Reference:
Issue Date: 1/26/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
, y. G
ELIZABETH A. NEVILLE ��� yt ` Town Hall, 53095 Main Road
TOWN CLERK y Z ; P.O. Box 1179
Prt
REGISTRAR OF VITAL STATISTICS � 1� Southold, New York 11971
MARRIAGE OFFICER 4:# 0l' Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER _ l * �a,.0 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ..�,,., southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
— 62004
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 6, 2004
Transmitted herewith is a copy of application No. 3382 for a Cesspool/Septic Tank Construction
Permit submitted by:
Stacey Bishop, For Robert Holzer
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: /Or-
•
Signature
62- 8
Dated
„"nf ,
ELIZABETH A.NEVILLE Town Hall,53095 Main Road
TOWN CLERK 3 _ P.O.Box 1179
REGISTRAR OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICER !" Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =y &V-of 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 @$25 Application No. 33g
Permit No.
Applicant Name Si?ac- NJ? CcT U ( n2...b2,1-1 nil SVS y,tJC.
Applicant Mailing Address /.56 ed o`er vfL-4 4J O4: S 1-Ara4 A j/9 7/
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration N( + S/AJ6( - A,M ,,y
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Location of Proposed Construction/Alteration:
Owner of Property: 4A,-.7 iyoc�Z -�r—
Owner Mailing Address: N. -�o� S in c z3-r — tau it t w o o r
Jf4,..1 ,I CZ-- O(6$/0
Owner Property Address: 33` s” /''l,N,✓4.4,4 N,' 66(40
ri-cLo /A7 (
Name and phone number of contact person ccs e N �76 s -6 7<7
Tax Map No:/OU a Section } 3 $7 Block 3 Lot /c7- (
Cross Street Oct A t SS A A�`
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
S' . . ��eofAPPS cant D to
i
Received by:
______ _ _____ ___. ..\ --.E.....<re-okr, ---
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N.% C.)4 ' ,
1-+c x V N
Z. iNi1Q)
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et) o°
s(i 4 'b a") teITEST HOLE
✓4L S Les , , ojry ,� a. lo•
` 4 �4�6NFr oy�4ti
O BROW AND PALE SIL TY SAND SAI
Sm A)p � 7
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_____,al'
WA 1ER IN PALE BROW SIL TY SAND Si
EXCAVATION INSPECTION REQU I -. ---
WATER IN PALE BROW FINE SAND SP
V�Q 20 .
vV
Existing house and garage not shown hereon to be removed. 15;,Trrivy,;,r-oL;N;-i D?�,VFT /EN;OT-I AL;II SERVICES
Existing septic system to be filled in. it r --- . .,,T. �' FOR A
"tf • � " ��jT• -•' i`-'^'1.11
I am familiar with the STANDARDS FOR APPROVAL cJ. G °":.4 ;`s`i iIT' _I>C :>LI
AND CONSTRUCTION OF SUBSURFACE SEWAGE f.";Alri 0-//' V . N.C.Xlq - OY%Vd9
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
and will abide by the conditions set forth therein and on the Ac?iiJ'-._`. • —'
permit to construct. t. . M \1 L'V;OF 5/ BEDROOMS
The location of wells and cesspools shown hereon are EXPIRES THREE YEARS FROM DATE OF APPROVAL
from field observations and or from data obtained from others.
ANY AL TFRATION'OR ADDITION TO THIS SURVEY IS A VIOLATION
OF SECTION 7209 OF ME NEW YORK STATE EDUCATION LAW.
EXCEPT AS PER SECTION 7209—SUBDIVISION 2. ALL CERTIFCATIONS `ASE OF Nth/
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY 'jr
SAID MAP OR COPES BEAR THE IMPRESSED SEAL OF THE SURVEYOR BONN T. METjG O.p�
NF/OS£ SIGNATURE APPEARS HEREON. � •'/ 110›,, ,. F� LIC. ANO. 4
Elevations are referenced to N.G. V.D. `
' ti !C VT; VOR: •-C
R=MONUMENT 1C :01 Vitt L (ink iiii4. (: ' 7. -,..q.--,"`i F631) 765-1
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