HomeMy WebLinkAboutKerbs, Jon . t
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ELIZABETH A.NEVILLE 1�� '` l0 : Town Hall,53095 Main Road
TOWN CLERK ; l l�[ , P.O. Box 1179
vs Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER '% Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER "Kr •, Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER - .COMA"� 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. 3353 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JOU & JANIS KERBS
Address 1: 430 RILEY AVE
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
SINGLE FAMILY RESIDENCE
FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT
Name Of Owner JOU & JANIS KERBS
Mailing Address 1 430 RILEY AVE
City St Zip MATTITUCK NY 11952
Property Address 1 SAME AS ABOVE
City St Zip 0000
Tax Map No. section 56.00 block 3 lot 11.000
Cross Street BAY HCS ROAD
Building Permit Number Cross Reference:
Issue Date: 9/13/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE e Town Hall, 53095 Main Road
TOWN CLERK 4 * P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS % cc)G Q
MARRIAGE OFFICER � �
�O Fax Fax(631) 765-6145
:
RECORDS MANAGEMENT OFFICER l ��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �COUry►,+�S � , southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
C�0 — 2 2005 ,y TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 3504 for a Cesspool/Septic Tank Construction
Permit submitted by:
John & Janis Kerbs
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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Signature
2 2-4445 -
Dated
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ELIZABETH A. NEVILLE ' Town Hall, 53095 Main Road
TOWN CLERK - t P.O. Box 1179
x Southold, New York 11971
REGISTRAR OF VITAL STATISTICS y. 11�
MARRIAGE OFFICER %: '� 1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER S 0`�r�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _el �a„.1southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 I or Non-Residential @$25 Application No.aiA-A
Permit No.
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Applicant Name 661x._ 4- Q-kA: 5 e.r SCJ S
Applicant Mailing Address 1 30 ',I Ave,
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Septic Tank or Cesspool
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Brief Description of Proposed Construction or Alteration k k l c
tCP
Location of Proposed Cons ction/Altera 'on: 60Kt&0 "� b 5�. u
Owner of e Pro GL, G..x,.. S e- -S
Property: U t
Owner Mailing Address: tf-tz RtP A v
1A,k7x 1.1_x - u2s" 2--
Owner Property Address: _.‘C-C- —
Name and phone number of contact person Jo (807 J I
Tax Map No: (ooi Section 'S-- Block 3 Lot l
Cross Streeto '1
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALT DEP TMENT APPROVAL
C_____ We) -S--
Si a of Applicant Date
Received by: T --�
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_ / -Ni Young & Young -. «�
Nander Avenue, Riverhead, New York 11901 lit
400 Os 631-727-2303 ;i
AREA 7,-424 SQ.' FT.
Eden W. Young, P.E. & L.S. (1908-1994) bt
• VERTIIGAL DATUM';- N.G.V. DATUM (M.S.L. 1929) Howard W. Young, Land Surveyor p`
Loas C. Wolpert, Professional Engineer £
m
'Robert C. Tast, Architect / Zi
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; ;
W ► _ E HEAT TH DEPARTMENT USE
t�� \ SUFFOLK CO
gni DEPA •':?'.�;;",TT OP.P..ALTH SERVICES 11
�e \ of existingsanitary G ^ ;+ ;` a; r `•5r,•';f2N1 FOR l`
Foc kike Abandonment system PEr?i3Tt: ,r. r.._fF.:.-.....!'.:.1".•::.:1:C-13 � • t,,
O( ,° SO to be witnessed lw Hor'.�1 reparfnlont. --i6r. c.l t .'i .. {
S o�9 CN ep0•\�e �o�a� `` �_ }�A �., � __... 1.;;;ar7 ;� 112 I.0-o?-022 2. Pil
rearps, �riir'' r/'I/I :.
Gr`�c4�`�` •�0 a0) 0-�• APPROVED '� -� '
`ora �O`1',o +, ��' o it ila:�? .:,`.�i(_I t;;>ROOMS
y a 4, �i a , ,�, MEE WARS FROM DATE OF APPROVAL F�
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,a� � o��`.'�, v-\Q t XOti .1 I SURVEYOR'S CERTIFICATION fib_
im.O*\tt Ste' y �\;r' "� \ t�\ Ai O "'44. �. cl
h� 5►`'\t►g no O alP• �N ,``. ca c. �'=�;\` ti+ • 3Y CERTIFY TO JON C. KERBS & JANIS E. al.
T' th. �CO`'v' `r4��\\ •off KERBS WE HER
IAT THIS SURVEY WAS PREPARED IN ACCORDANCE ,"
o %� p o"\'-9-.,,,.. -'` `\ .0 WITH THE ( OE OF PRACTICE FOR LAND SURVEYS ADOPTED BY
' ti S �• � iK STATE ASSOCIATION OF PROFESSIONAL LAND o
.. 9 THE NEW 1 _
per_
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,�\��� <<' \ =�q, �� SURVEYOR! 111 4,4
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TEST HOLE o `' o o `\ �► ,-''�� - o )33o
DATE:-11/05/02__. RR N� e 1 \r O� +- ' fOUNG. N.Y.S. L.S. N0. 45893\ 9
ORO SF- �'� 4 F�' • 1 4 �� HOWARD W. `_ t") 45895
Of �'- 60• 6FD LAN)S\1
ROWNOA ( 1/4
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SILTYBOAM Q.__ 1 �J� ;,\y
(oL) ,�, �' C SURVEY FOR \ ix!
1.0. F.�P -' 1/:.:
LOAMY SILT OSP d ---- °5' KERBS & JANIS E. KERBS ._.:
(ULI PO JON C >f
od �Q t Southold, Town of Southold +3e
PALE BROWN ,/ ,-' \� • Suffolk County, New York is
COARSE SAND •'- . Ai
(SW) Mop District 1000 section 056 Block 03 lot 11 Isar q
County TR
BLit! PERMIT SURVEY • o'
WATER IN
PALE BROWN \ - 6j
FINE TO c DEC. 20, 2002 Pei
COARSE SAND • •
(SW) NG PERMIT DATA NOV. 12, 2002
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ADDED BUR :D JULY 22. 2002
MAP PREP/ ett
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17.0' 40 Q(�
SCALE 1 ( r-034,' BI— �6
• JOB NO. 2 341_bp J l
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Q- MONUMENT S - MONUMENT FOUND A - STAKE SET •. STAKE FOUND J ` DWG. 2002.
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