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HomeMy WebLinkAboutFree Form Building Partners (2) %;ofsoiit4- ELIZABETH A.NEVILLE /1 �O !O : Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS N eV Southold, New York 11971 MARRIAGE OFFICER �� '� . /�� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER '�i Telephone (631) 765-1800 urV FREEDOM OF INFORMATION OFFICER `= Un �o� � 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. 3355 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 NEW SINNTE FAMILY DWELLING FINAL APPROVAL REQUIRED FRCI4 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 17.230 Cross Street NORTH BAYVIEW Building Permit Number Cross Reference: Issue Date: 9/13/05 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) • ` 1 ��, 010S002, ELIZABETH A.NEVILLE to h0 4 Town Hall, 53095 Main Road TOWN CLERK i 41 41 % P.O. Box 1179 co Southold, New York 11971 REGISTRAR OF VITAL STATISTICS % G MARRIAGE OFFICER 1� 4 ..%z 19 Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER - l ��� Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER - _ COUNT I,* � , southoldtown.northfork.net 0'S • 7 t ; ' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD ' " cr- _ 6 2.005 ULi, 4 1 r Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: Transmitted herewith is a copy of application No. 3506 for a Cesspool/Septic Tank Construction Permit submitted by: FreeForm Building Partners Lie. 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: i ' APPROVE DISAPPROVE Comments: '� ,frio_.:Z_e_Ca_ \� / / //rte ‘eig/ -et• Signature 9s-- Dated • OFFICE OF THE TOWN CLERK ,,,'""""' Town of Southold ,�,•'i, C41 ULK ,l/ Application No. Judith T. Terry, Town Clerk Town Hall, 53095 Main Road ,`" Construction P. 0. Box 1179 ; o m Southold, New York 11971 kc1'i ���• Alteration Tele hone _ ,j, $10.00 - Residential p (516) 765-1801 =�01 l ' $25.00 - Non-Residential • TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. JrAL) Fee $ DATE APPLICANT NAME: 4( z'FD RM LD 01/43 6- S{ hi Q-6 : 1A-1- APPLICANT ADDRESS: 11+1- t \eV`&. SEPTIC - CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION 63n -1 CAW i �. 1'3 e (.1v‘ tkA. 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: TAX MAP NO. : Section )n00 Block � -�-� Lot /1` 23 CROSS STREET: /&M MA(4 l Idet Ae,y R.N./1t BUILDING PERMIT NUMBER CROSS REFERENCE: 1110./ •natup ican RECEIVED BY: Town Clerk's Office DATE: - IAT AREA = 83.771 SQ. FT. NOTE LOT CLEARING SHALL BE LIMITED TO 1 ACRE F.FL EL.EV • 28.0 GAR ELEV 26.0 L. r, )Or F OLK CO QTY X 2005 JUL `r `'; j: -V 4 _ VACANT 01_ LOT NUMBS 24 6) (25.5) 298.36. R=85.00' S 8741'29p E L=71.75' NiGE 15.08' FJSEM (23.0) 841. g' ORN g6.67' 13 =25.° 2g 47' i 4LIFFOLA COUNTY DEPARTMENT or HEALTH SERVICin ES R - PERMIT FOR APPROVAL OF CONSTRUCTION FORA (28.0) s27. tiSINGLE FAMILY RESIDENCE ONLY (26• ao.o' ' �y N. N1 ►7 1'4 Q�. H.S.REP.NO. / i) ..-O I-0)6 '� li NOTE ~ DATE 7�� I Ci o W APPROVED <6-4. � 1 ProFooed 44 I W co FOR MAXIMUM Or, b BEDROOMS (26.0 II 38.0' A EXPIRES THREE YEARS FROM DATE OF APPROVAL (26.0) IN 1 woa`yr4i� «ryrce a 2 z 9 a in 1 to NATURAL & UNDISTURBED In in VEGETATION RETENTION auF> RR-25.00' (2s o 1-39.27' N 73'05'20"W (24.8) 305.61' (25.8) -NORTH BAYVIEW R E:; SYSTEM S �: ROAD I-ICO GAL.SEPTIC TANK 2-8•DIA.LEACHING POOLS.8'DEEP 10-- © y - 01 C $ 6 - 20 - 2005 REVISE SANITARY SYSTEM 12-10-2004 REVISE SANITARY SYSTEM TIE 010101 MR Mitissatio seam woe 81011 THE IMUMUREI TO THE FROF®In MOM OM FOR A OPIMM MIME MO U.r Mb 11+0110r1IE ME NOT JOB No. 04-262 FILE No. ZOUMAS CONTRACTING MOOD To ROM Mt MOM of mew Nevem S.us. FOOL. MTI0% Fw,rra MClil.110oM.N 10 WUIQS 0R MY ORM OOM UMON. SURVEYED FOR uNIMMO ZED AMMON OR AM MON 10 M. SURVEY a A Mauna+ OF mem LOT NUMBER 5 7100 OF TAE MR YORK SOOT EOLO ON UM. MAP OF ZOUMAS CONTRACTING CORP. mew=mom Hew sivo.*w AMY io THE FsttlllOtl FOR 0101 ns SITUATED AT BAYVfSW aeeillli • MO 011Iw AeS.M A1K.rrllrrle1l ea. #1 l 40 .. ..4I!*LII 1loN.TO UIr TMo Mo eie/lrl s aF Tiit rilrial Nrar10 a ME Nor 111"1 es Ta 141mo1".nr inni°1a TOWN OF SOUTHOLD. SUFFOLK COUNTY. N.Y. oo n or lis re�y sir rdm Ti wec'iio w ee SEX as SCALE 1' 80' DATE 10-15-2004 1 1111100111116 Fiat ma. 1 TOM A --`RMIC i-. FILED MAP No. 11186 DATE 10-01-2004 CERTIFIED ONLY TO: TAX MAP No.(REF ONLY) 1000-79-4_P/0 17.17 DISI( 2004 HAROLD F. TRANCHON JR. P.C. LAND SURVEYOR t P.O. BOX 616 (441 ` F '- .0.... - <: .`"", 1865 WADING RNER-44A1+ RD WADING RNER, NEW YORK, 1-1702 N.Y. LIC. No. 046992 631--929-4895 HAROLD F. TRANCHON JR, PENN. LIC. No. 2116—E