Loading...
HomeMy WebLinkAboutHubbard, Susan S3FFO4�; ,' y fir/ ELIZABETH A. NEVILLE eyA` Town Hall, 53095 Main Road TOWN CLERK this Z ; P.O. Box 1179 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS ` /t°41 MARRIAGE OFFICERAr Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER '-4l * NVO I. 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. 3275 R Residential x Non-Residential Fee $ 100.00 Septic X Cesspool PERMIT ISSUED TO: Name : ARTCO CESSPOOL Address 1: 4225 BRIDGE LANE City St Zip CUTCHGOUE NY 11935 Descripton of Proposed Construction or Alteration ADD 1000 GALLON SEPTIC TANK AND 1 8 x 8 LEACH POOL MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIE. EXCAVATION INSPECTION REQUIRED. Name Of Owner HUBBARD, SUSAN mailing Address 1 P 0 BOX 502 City St Zip MATTITUCK NY 11952 Property Address 1 1380 BUNGALOW LANE City St zip MATTITUCK NY 11952 7ax Map No. section 123.00 block 2 lot 1.701 Cross Street CENTER STREET Building Permit Number Cross Reference: Issue Date: 2/01/05 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) 12.15 SA0FOurco G ELIZABETH A. NEVILLE ��P ��` Town Hall, 53095 Main Road TOWN CLERK y Z P.O. Box 1179 REGISTRAR OF VITAL STATISTICS ` Oy\:°1491 Ol4,� Fax (631) 765-6145 New York 11971 1 Southold MARRIAGE OFFICER ; RECORDS MANAGEMENT OFFICER : f j * **s,.,° Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER .��,,,�s•� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD JAN 5 TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: January 4, 2005 Transmitted herewith is a copy of application No. 3419 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Artco Drainage for Susan Hubbard 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. * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: Maintain required setbacks from adjacent wells, buildings, property lines and water Bodies. EXCAVATION INSPECTION REQUIRED. 7/V4/aq Signature Ol /47/6-- Dated 07 eDated Oii 0 C , ��h`1`Ay OGS`� Town Hall, 53095 Main Road ELIZABETH A. NEVILLE i TOWN CLERK p P.O. Box 1179 VA Z 1 Southold New York 11971 REGISTRAR OF VITAL STATISTICS y. ' MARRIAGE OFFICER % G V $ Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER \y O�ii�� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER 0'� �a.�� 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 @$25 Application No. 3 7 / 9 Permit No. Applicant Name �G/_ rild�i9/z� lei�r�v �SSPv� Saar 64,e,e L.. Applicant Mailing Address Z9tfyift4xo., ; " k C . /1/1 //7.52-- Septic /7 ZSeptic Tank i/or Cesspool Brief Description of Proposed Construction or Alteration .,-.09G�G," /Pa9 I.4AG . i' IG .r' . .1,e/ / 8x8 l ivGit_ poa/ Location of Proposed Construction/Alteration: Owner of Property: ,�C - "3 8D 43l�, )6J -O&) 44.)X10 Owner Mailing Address: � PO 6Y. _aip inti-7"7 - vA Owner Property Address: irze Name and phone number of contact person a4// 4&2" �itk.o .5/4) 903/039 Tax Map No: Section to)., Block cZ Lot /7. / Cross Street C',' u " NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALT I EPARTMENT APPROVAL 2 Signature of Applicant Date Received by: _ SURVEYED FOR:- .j 4_45..441 NU .4 , LOCATED AT /V/AT]-iTv c__ �o u/.c/ ac- hoc-�'7'Nr�o, J2-1 Ca. ,c y A - LOT /5 DE5CRi5 z e itpMme, ,qs �Norc%c/ k- 1 SCALE r- 3 0 ' ff iliji CitiEPE TSE ET T C A-//= Z. "-c--,e&A.J g Do •i� �c./80;5-7"oo Q ell tsvo V i e7.G i 8." _ - - - ci \0 ©/,Q T 1 17.42 IV Q is- -+ aQ J0., !i e'll / -15-7X- ' 4 "9 m -- 1 O acp5•e Gamti :11 . =r ,0 ,,,. .o©^w 2/69-2.5 t, SNa«. EL T�vcif2��7�// // �,OM STRUCTURESc't/s a,v. HU�3E3.n,2n `' bi '$OUNDRY LINES/ / VEY::. tt.aAnt r',�7 -Y HOM ' /1/70,47 .4G414 ("1:!!;;I)T5 ,'-.ARE FOR AlE )NC'r, AND Z A" Sl'IOULr" '_ SURVEYED J,n�/, 22, 19 7 BY g ' SG�c ,r4 ^ ,rar f ' 3. vE :► I 2 �A ,412 ._..� T ., P. a. 8• k 4-= Y ? �f/ ii ,A ST Iv'in f cNE.f., K( y, 1 1940 ` 7.;. .._�_. s _ - cr.-7 FILE NO. /4043 PAGE GRID Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 01/04/05 Receipt#: 0 Transaction(s): Subtotal 1 Septic Permit- Construct- Resid. $10.00 Cash Total Paid: $10.00 Name: Artco, Cesspool 4225 Bridge Ln Cutchogue, NY 11935 Clerk ID: LINDAC Internal ID:104343