HomeMy WebLinkAboutJacobs, Peter (2) I0 \4 0° FOL4 -
ELIZABETH A. NEVILLE 1') yd` Town Hall, 53095 Main Road
%TOWN CLERK co,� = P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O 1� Southold, New York 11971
MARRIAGE OFFICER .`4 0. 0 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER - 41 * 10' ' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - ,.1.ti 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. 3288 R Residential x Non-Residential
Fee $ 10.00 septic x Cesspool
PERMIT ISSUED TO:
Name : JACOBS, PETER & MARY
Address 1: P. 0. BOX 614
City st Zip EAST MARION NY 11939
Descripton of Proposed Construction or Alteration
2850 SQ FEET--SINGLE FAMILY RESIDENCE
FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HELATH DEPARTMENT
Name of Owner JACOBS, PETER & MARY
mailing Address 1 P. O. BOX 614
City St Zip EAST MARION NY 11939
Property Address 1 940 GILLETTE DRIVE
city St Zip EAST MARION NY 11939
Tax Map No. section 380.00 block 2 lot 10.000
Cross street MANOR ROAD
Building Permit Number Cross Reference:
Issue Date: 2/10/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
,,,,,,,._ 2-2-
- 41141111r .,�o\OSUFFO�,�co
ELIZABETH A. NEVILLE �� a y Town Hall, 53095 Main Road
TOWN CLERK t�ia Z $ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O �1� Southold, New York 11971
MARRIAGE OFFICER � 40,* Q� � Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER _= /1 * #,d° Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,•ssop southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
rigeo
TO: Southold Town Builc ling Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 3, 2005
Transmitted herewith is a copy of application No. 3432 for a Cesspool/Septic Tank Construction
Permit submitted by:
Peter & Mary Jacobs
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: vr - 1-1"4.- )441-‘..' "
s
7
Signature
O.3- D VAS'
Dated
• ',•//iii%-
•
ELIZABETH A.NEVILLE �`t` 04 Town Hall, 53095 Main Road
TOWN CLERK ; P.O.Box 1179
REGISTRAR,OF VITAL STATISTICS v, Southold,New York 11971
MARRIAGE OFFICER : O !,�� Fax(631) 765-6145
�ae'
RECORDS MANAGEMENT OFFICER ` . e,/ Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER 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 ,4/or Non-Residential @$25 Application No. 3q
Permit No.
Applicant Name WA-exA Kos‘.i 3;A Lob S
Applicant Mailing Address P- O . aoX (o l } t_o f I` os ov1, l 19 3 91
Septic Tank or Cesspool /
Brief Description of Proposed Construction or Alteration 'a5 b sq -I+ s j r-LP rni
Location of Proposed Construction/Alteration: ci pr v e 6a5-k- M.A r i c ,t' - 11`f 3 1
Owner of Property: L.-k r t 1l tcW. STA C Cb
Owner Mailing Address: P•D. box £, ri pe(l on, N`�, I 11-5 al
Owner Property Address:9 L f D GI EU.-VW Dr ve ,m A Y 1 O r1
Name and phone number of contact person Pec( t- t-t t 'i J A c OLS
Tax Map No: Section Block - Lot (0 II
Cross Street t 00 C7 3 8 a MANOR �-CI
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signature of Appl ant ate
Received by:
i-:
s
,
SURVEY OF LOT 24 N
MAP OF MARION MANOR '(
FILED MARCH 18, 14153 FILE No. 2038W - E
SITUATE: EAST MARION
TOIHN: SOUTHOLD
SUFFOLK COUNTY, NY . S j
SURVEYED 03-01-2004 =t
AMENDED 01-08-2004, 01-21-2004
SUFFOLK COUNTY TAX # `
1000 - 38 - 2 - 10 Test Hole
CERTIFIED TO: ®� Dark
&'own
silty
Peter J.Jacobs �� `•��l®4 Loam 1
Mary Jacobs \� '` °
Columbia Ltd. Brow
Loamy
s
Fidelity National Tide Insurance - moi`
Company of New York 3
ig
F-
2 Pole
S,O
Brow
I
Fine
to
'
.Q.' �- GOCY'eb
San
•
13'
VPale
lqbb Broom
Fins
.0 to
P.
O, medium r
Sand
PO\° 17
• U
\l'\°\-\NCI
��¢ �' to0 'z
vat` �• Nik- s o,
Pv' \'\o 0" 1 d4.. eetA 6
111F.VVK
T: ; \
E
a \ % $.
P
%
y °m k
(5 -\ si.: A,-0- ,i6a
• r z2 \
O
SLS �\ 0 ( �
o ••
\-2A `, ti0 c ° 11
G a
•09-°'CP— _,,, 0, , �" \
4
L
S
I- e C
y� ya�j`�04 �` 9:UFFOLK COUNTY 0 PARTMENT OF HEALTH SERVICES
<��y� PyoF°"�of PERMIT FOR APPRO AL.OF CONSTRUCTIONS FORA
S _
��0.� \.�P SINGLE FAN!+Y RESIDENCE ONO'
s-1, o\ 23 5" DATE 17A0/6/H. EF.. 0. nib- j--`00 J
7,,o� APPROVED (a 1 44 ' Y -'
1 \''s\
FOR MAX I M OF A BEDROOMS :
0-N EXPIRE ' 4 E YEARS FROM DATE Or APPROVAL
o
Cfi
v.:\-
NOTES: P r� OF �a.. .;� r�
G'At;�no`` C. Eh. 0� 'u,anthorized mterat.on or addition to a sc.,-,,y
A STAKE FOUND ' c Y 4,s, •� `�, -p bearing a icen<,ee latl evrveyorb xai b a
i �loiat�on°f eecuan,ion,wo-dwykzn�.or trb
•f Nod York State Eeucntbn Lnn'
AREA = 10,000 SF OR 0.23 ACRES * R rke`ith on from
o the l n ""savoy maked r,ltn an original f the lad verve
�► -�A .� zea,pee eem ehn I be aommered to be mol d o-�e
4. ..1 opies
S.C.D.H.S. No.RIO-OI-0081 C 'i fo a, /� •`ert'frat,n=nmaated herean,gnlfy NI.
`,�— Q'.,�,--- t+„ wrvey rvos prepared In accarduice With fhe ex
PROPERTY LIES IN ZONING DISTRICT R-40 op o yttheNe aatSttaefariftntey,adopt,l
�'� � by the Nen York State Aesocialbn of Rofesslan
Lata ra..veyorn Saki ceroScal ons snot rce on y
�� V !o n h person for Whom le wrvey b prepared
\ AA LAND
t 41x1 on c ood to tree title company be coo,irwl-
\Y _ LA; D S tol agency and ending Mt tvllon Ibted hereon,°red
AREA OF PROPOSED HOUSE EXCLUDING PORCH 15 1,95c1 S.F. n dre a,e�ee,°` "d'n9 we"�tlan `er°Kk°
_ -- tkma are rot traeferab a!o additlow betitubae
ELEVATIONS SHOWN REFERENCE SUFFOLK JOHN C. EHLERS LAND SURVEYOR
COUNTY TOPOGRAPHICAL MAPS. 6 EAST MAIN STREET N.Y.S.LIC.NO.50202
GRAPHIC SCALE 1"= 20' _ RIVERHEAD,N.Y. 11901 REF,\\Hp server\d\PROS\01-125A.pro F
NM 369-8288 Fax 369-8287
ax
----_ - - - - --- _ _I
—
--- 9n242004 5,7%421.1 \Via mrwrSe Maul-150.4.6 '
I