HomeMy WebLinkAboutSuspenski, Stephen (2) at$004,
ELIZABETH A.NEVILLE ;,i,tib 0,, Town Hall,53095 Main Road
TOWN CLERK * * ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICER ,0, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �� iTelephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER Cty, ,� southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3344 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : COURTENY GALLAGHER
Address 1:
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
SEPTIC TANK WITH A CESSPOOL
FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT
(631) 852-1400
Name Of Owner STEPHEN SUSPENSKI
Mailing Address 1 34 DRAKE LANE
City St Zip LEVITCfn1N NY 11756
Property Address 1 1205 EDWARD LANE
City St Zip ORIENT NY 11957
Tax Map No. section 18.00 block 3 lot 19.000
Cross Street C.R. 48 & EDfn1ARDS AVE
Building Permit Nunber Cross Reference:
Aedittif0 7 ...#01/4
Issue Date: 8/24/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE I / Q Town Hall, 53095 Main Road
TOWN CLERK *; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS N Southold, New York 11971
MARRIAGE OFFICER �Q �1�, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER Ol� ,0 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER = COUNTY\ .,� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
JUL L 9 2005
i k '--
T Southold-Tow Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 3494 for a Cesspool/Septic Tank Construction
Permit submitted by:
Courtney Gallagher
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:
9W(.444.1.4gite°
Signature
apP-4,46-e 1-10D.S—
Dated
0,����Of F04
. ELIZABETH A. NEVILLE ����`1`� j� ; Town Hall,53095 Main Road
TOWN CLERK l P.O. Box 1179
ft ; Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS f1i
MARRIAGE OFFICER ‘°O t 1� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER \*** O��i�l Telephone(631) 765-1800
4 �
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 / or Non-Residential @$25 Application No. --1 CI 4
Permit No.
Applicant Name I.OVIi/ eqC1
�
Applicant Mailing Address PO c )(,, 1-17
Septic Tank Yor Cesspool zo
Brief Description of Proposed Construction or Alteration ( T - ,,, .k
C`
Location of Proposed Construction/Alteration:
Owner of Property: 3 .pka n �l �
Owner Mailing Address:
0 9-u __ 7
Owner Property Address: e 0 j uock( t
O \J 9- ,.- - Y L(
Name and phone number of contact person (}u 12_41U/1 g(01 bc1h,er 7(4
Tax MapNo: 1000Section Block 0 3 Lot C 1-MU
� � � 1
Cross Street a O i s I � i�
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES S T: • T: I EPARTMENT • ,'PRI,VAL
PP-
-A 7 Dy 05—
gnature Applic.111, Date
Received bye �-
-4 t
c
r ai I �V9
`A ti SURVEY OF PROPERTY
�,,k°. '.0, AT ORIENT
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TOWN OF SO UTHOLD
=; 17 �� SUFFOLK COUNTY, N. Y.
'- r �'.`'. �'' 1000-18-03-19
- )� ; i Aot� °� . 00,, SCALE. 1 -50
�, .. �p� ��,� oQoJ� F G>„�,���o MARCH 18, 2005
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To
F'. �� V. 110,vz\� y 0� { SUFFOLK COUNTY DE .RTMENi T OF HEALTH SERVICES
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S 13
\ '9:4 i PERMt 1'O t Pae ''Y .CI TRaUCTION FOR A
;iiGirt r Ll',7;71' '7_:•]7:71:I4C.727 OPT,Y
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4.0. APPROATED __,
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0------- FOR rvIAXIMiiM at- 14,_ „3".::.---2.0c,,ms
XPIRES FROM OF APPROVAL
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$ A#40•0 ,---, _ 7,. g roo �V*Ol \ . es.ra \ —
`\ -off\ P 3\:7- \i'°\'
, p \i \ c4,- 0'
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a\ +',. / am familiar with the STANDARDS FOR APPROVAL -
\ _9 \ -� AND CONSTRUCTION OF SUBSURFACE SEWAGE
°'. �m Y �0 & \ DISPOSAL SYSTEMS FOE? E FAMILY RESVENCES.
�%�\ \\ t ZI- and wE abide by the conditions set forth !beret, and on the
�`'0 00 30. A iii:I _F" x- d<ps to permit to.construct.
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Lx._x—xJ ,�� OD
1,(6.14.6AREA=98,687 SQ. FT.
it' P�oQ�� qy S.
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,y '1, n N650 96 • =REBAR
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49 ?as / POs. P° Brown sill ban OL
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P9 lr Pall eror.4. $•g. �P��oF NEwyO
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et foo Io'F gar s� O� 5 'Pf
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ted• '�. �4r5�°",
The locations of wells and cesspools 1
/ R i s 9618
shown hereon ore from field observallons V2 ANY ALTERATION OR ADDITION TO THIS SURVEY ISA VIOLATION / ECONIC • . Ye r .t ' ,
and or from data obtained from others./ OF SECTION 72090E THE NEW YORK STA 7E EDUCATION LAW. (630 765-5020 F' - —1797
'J. 4, EXCEPT AS PER SECTION 7209—SUBDIVISION 2. ALL CERTIFICATIONS
--% HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF P.O. BOX 909
ELUTIONS ARE REFERENCED TO AN ASSUMED -�-\ SAID MAP OR COPIES BEAR 7HE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAVELER STREET - q
1YA14._ --S,, WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N. Y. 11971 OtJ_2�fO
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