HomeMy WebLinkAboutFree Form Building Partners L Y
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ELIZABETH A.NEVILLE � � l0 : Town Hall, 53095 Main Road
TOWN CLERK l l P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS G bL
@ ,� Southold, New York 11971
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER '4. 44. i.�, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ' . OII111�'0's°���� 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. 3354 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : FREE FORM BUILDING PARTNERS
Address 1: 142 MINEOLA AVE
City St Zip ROSLYN HEIGHTS NY 11577
Descripton of Proposed Construction or Alteration
SINGLE FAMILY FRAMED DWELLING WITH APP. 6 B.R. SEPTIC TANK
FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT
Name Of Owner FREE FORM BUILDING PARTNERS
Mailing Address 1 142 MINEOLA. AVE
City St Zip ROSLYN HEIGHTS NY 11577
Property Address 1 DEER RUN
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 4 lot 17.220
Cross Street MAIN BAYVIEW
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 '` O . Town Hall, 53095 Main Road
TOWN CLERK ; li lg 1 P.O. Box 1179
ua Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS G Q ,�
MARRIAGE OFFICER -;(% . e Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER l Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER =.. uU ,t°8.°��
' southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
! SEP _ 2005 TOWN OF SOUTHOLD
L.
TO: - Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 3505 for a Cesspool/Septic Tank Construction
Permit submitted by:
FreeForm Building Partners Llc.
Please review the application and location map and advise if the project has received Suffolk Coity
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:
Signature
Dated
OFFICE OF THE TOWN CLERK ,,,'"""
Town of Southold Application No.
Judith T. Terry, Town Clerk �' G
Town Hall, 5305 Main Road � . • Construction
P. O. Box 1179 o
Alteration
Southold, New York 11971 t!;
Telephone _&\%c , $10.00 - Residential
(516) 765-1801 �1 , $25.00 - Non-Residential
• • I,,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. :-?).5(.573
Fee $
DATE 9/715
APPLICANT NAME: (1..66or
APPLICANT ADDRESS: 10-- MAyte lo- fr„2
o ' e - NI 11.5 77
SEPTIC ✓ CESSPOOL ✓
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION IJP.u.)
bit tmt�yv� -c.r+�� Dietl t 6 `� ' Th aee,�Ne.�l 6 g�
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: avid I]J2r 514'771. 70,190
TAX MAP NO. : Section fOot) Block 7- y Lot /7. -
CROSS STREET: / tuika N . Me' 8A-YVletA)
BUILDING PERMIT NUMBER CROSS REFERENCE:
dl.
Signature of Applicant 77 RECEIVED
--
RECEIVED BY:
own Clerk's Office
DATE:
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LOT AREA..82,635 SQ. FT. NOTE LOT CLEARING SHALL BE LIMITED TO 1 ACRE
F 'FL ELEV 27.5 + . ,
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LOT NUMBER 5 — VACANT
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6 - 20 - 2005 REVISE SEPTIC SYSTEM
THE OFFSETS (OR DSIENWONS) SHOWN HEREON FROM THE STRUCTURES TO THE
PROPERTY UNES ARE FOR A SPECIFIC PURPOSE AND USE ARD THEREFORE ME NOT JOB No. 04-262 FILE No. ZOUMAS CONTRACTING
INTENDED TO GUIDE THE ERECTION OF FENCES. RUNNING WALLS. POOLS. PATIOS.
PUNTING MEM ADDR11ON TO BUILDINGS OR ANY OTHER CONSTRUCTION. SURVEYED FOR
UNAUTHORIZED ALTERATION OR ADDIRON TO THIS SURVEY IS A VIOLATION OF SECTION LOT NUMBER 4
7205 OF NE FEIN YORK UNE EDUCATION LAW
cu IEES INDICATED HERON SHALLT
RUN ONLY TO E PERSON FOR WHOM THE MAP OF ZOUMAS CONTRACTING CORP
AN
SURVEY IS PREPNIED.AND ON HIS BEHALF TO THE TILE COMP*" GOVERNMENTAL SITUATED AT BAYVIEW
AGENCY AND LOOM INSRRJTION LISTED HEREON. AND TO THE MATINEE'S OF THE
LENDING INSTRUTION. GUMWIIEES ME NOT 1*114aeLE TO Aoa►aNAI INSTItftwNs TOWN OF SOUTHOLD, SUFFOLK COUNTY, N.Y.
OR SUBSEQUENT OWNERS.
COPIES OF THIS SURVEY MAP NOT WARM THE IlND SURVEYOR'S INKED SEAL OR SCALE 1" = 60' DATE 10-15-2004
EMBOSSED SEK SHALL L NOT BE COMMUTED TO BE A VALID TRUE COR'.
FILED MAP No. 11166 DATE 10-01-2004
CERTIFIED ONLY TO: TAX MAP No. (REF ONLY) 1000-79-4 P/0 17.17
DISK 2004
HAROLD F. TRANCHON JR. P.C.
LAND SURVEYOR
P.O. BOX 616
1 ,-...4 F -. 1866 WADING RIVER-MANOR RD. WADING RIVER,
NEW YORK, 11792
N.Y. LIC. No. 048992 631-929-4695
HAROLD F. TRANCHON JR. PENN. LIC. No. 2115-E