HomeMy WebLinkAboutZahra, Richard (2) • g
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3303 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : RICHARD ZAHRA
Address 1: 23 WOOD AVENUE
City St Zip ALBERTSON NY 11507
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-05-0022
Name Of Owner ZAHRA,RICHARD
Mailing Address 1 23 WOOD AVENUE
City St Zip ALBERTSON NY 11507
Property Address 1 445 MARLENE LANE
City St Zip NATTITUCK NY 11952
Tax Map No. section 143.00 block 3 lot 29.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 5/18/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
A
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ELIZABETH A. NEVILLE •
Q Town Hall, 53095 Main Road
TOWN CLERK 4g 4g% P.O. Box 1179
REGISTRAR OF VITAL STATISTICS N bc
Southold, New York 11971
MARRIAGE OFFICER % e jx Q��� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER %YeA �0 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER =.COUM,' ,.�� southoldtown.northfork.net
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` 11\ FFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: \- Spiitht k.I'c7t#icl ing Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 25, 2005
Transmitted herewith is a copy of application No. 3447 for a Cesspool/Septic Tank Construction
Permit submitted by:
Richard Zahra
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:
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714(4:44.—a,‘t. .. .)
Signature
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Dated
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400 4:9
ELIZABETH A.NEVILLE ��0 4\; Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v, Southold, New York 11971
MARRIAGE OFFICER : O .11 I� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = f0 40lrr� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER - '� r�rr 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. 34'4-7
Permit No.
Applicant Name /c%/A#eD ZAgie.4
Applicant Mailing Address 3 hued 0 Av-
A1 . )e2 j So.v /V Y !1567
Septic Tank ✓or Cesspool ✓
Brief Description of Proposed Construction or Alteration 40 /ius,z-r;
bQLt,ti e/4. k. 1.1.6' AiS..1i.
Location of Proposed Construction/Alteration:
Owner of Property: Ave4-Alts ,P/chi Adzo g 1//Z.4
Owner Mailing Address: .2 3 sAy spa A v
Altai=f'TSOA, y /3-67
Owner Property Address: /Ice t /E G/a
/-/A,77-/Tuck dvy 1/ 95".2_
Name and phone number of contact person Ric;Is,42 p z/Iht .i />y/-y.5-,i s, 37S 3357
Tax Map No: Section /413 Block 3 Lot _29
Cross Street //A/.v 1Po a D
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEYWI WITH HEALTH DEPARTMENT APPROVAL
Signature of Applic Date
Received by:
11 1 I 1111 II I I II l J.11 IIIIHJ 1 111111 I!II VII I tlIII Illi II ._J...L1a ,.. .
i .�.. .. .. .... �......� ..... .. .. .... . .. . .. . ... . ..... . . ..... . ..
N [1] 1,000 GALLON SEPTIC TANK Al AVIA 1 1 ii V till
r TOWN OF SO UTHOLD
[2] 6' DEEP x 8' DIAMTER LEACHING POOLS SUFFOLK COUNTY, N. Y.
EXISTING SEPTIC SYSTEM TO BE FILLED IN. 1000-143-03-29
SCALE: P=30'
JANUARY 3, 2005
Jan 05, 2..7(.,s- (,teY:;;a %s)
19
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SUFFOLK.COi.II d 'FN4Ei T OF IL.+�LTH SERVICES 0/F RO PUBLIC 1�3 69 �x .� N�
PERMIT n.Ar..?.'4d .: ,es'*!1:1. .w«.•.t._ —1: 'FOR A �'= 'L
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i DATE. 2_ 1 0 s REF,. -a , , � 5 - .02--� .20' G*E �/ ,» f \o
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A ROVEt) /�!.4�. s�/�t�ail: 1469 5.10' , / Swb"11 1\ k.
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rOCPIRES THREE YEARS PROM DAA oie APPROVAL • / ,/ — C� `1?"
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D ;t`D 395 r#0,_ IV
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WATER IN PALE BROWN FINE SAND SP TA �► `' /ARpP/� 0 5 �O vp,GPN��
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I am familiar with the STANDARDS FOR APPROVAL 9 E� 30.4 LUNG
AND CONSTRUCTION OF SUBSURFACE SEWAGE \ (OSE
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES '\-- �',��OF NSW y4
and will abide by the conditions set forth therein and on the g 't•METZ
permit to construct.
The location of wells and cesspools shown hereon are * F' . ?.
from field observations and or from data obtained from others. ` '� '
ANY ALTERATION TION OR ADDI TION TO THIS SURVEY 15 A VIOLA TION / r 4,
•'* ' N. 4 ''' ~.1+•
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. -� '�:;�
EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS 'ECONIC R'VEYORS, '..
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF (631) 765-5020 FAX (631 65—
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR P.O. BOX 909
WHOSE SIGNATURE APPEARS HEREON. .
Elevations referenced to an assumed datum. 1230 TRAVELER STREET 04—c
SOUTHOLD, N. Y. 11971
\ AREA=14,575 sq. ft. • =MONUMENT