HomeMy WebLinkAboutMeyer, John SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3409 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : SANDRA SAVAGE
Address 1: 1814 MIDDLE COUNTRY ROAD
City St Zip RIDGE NY 11961
Descripton of Proposed Construction or Alteration
-NEW HOME
-FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT
Name Of Owner JOHN C. MEYER
Mailing Address 1 P 0 BOX 549
City St Zip SOUTHOLD NY 11971
Property Address 1 SLEEPY HOLLOW LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 1 lot 38.000
Cross Street WILLOW POND LANE
Building Permit Number Cross Reference:
Issue Date: 2/23/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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•o,•*q SOii1,
ELIZABETH A.NEVILLE �� l0 : Town Hall, 53095 Main Road
TOWN CLERK � 1 * , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS G Q � Southold, New York 11971
MARRIAGE OFEICF E-1 �`' -O��� Fax(631) 765-6145
ORBS .E E ICER : , ,� Telephone (631) 765-1800
RRED M?f1F I]VF FICER '!COUN11170.. southoldtown.northfork.net
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JAN 3 OFFICE OF THE TOWN CLERK
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. 3562 for a Cesspool/Septic Tank Construction or
Alteration Permit submitted by:
Sandra Savage
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:
Signature
a$4,144,44." 3 j avo
Da
ELIZABETH A. NEVILLE I� •j•� \•
� I` � , 1 rTown Hall,53095 Main Road
TOWN CLERK P.O. Box 1179
x : Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS � �y. I1�
MARRIAGE OFFICER : G t Fax Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER %.:**� a0* of Telephone (631) 765-1800
=
FREEDOM OF INFORMATION OFFICER _. * *ell' southoldtown.northfork.net
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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 • _11. r,
Permit N..3
iiic
Applicant Name .Sc*,v dA ',rr 5,p,Jo,9.1 -e
Applicant Mailing Address 155 1 y YV1 \ c1d I -Q c-- -k-r\ 4-11
e;d -Q 119tok
Septic Tank or Cesspool V
Brief Description of Proposed Construction or Alteration Oe ' 1-to i-k_5-c.
Location of Proposed Construction/Alteration:
Owner of Property: J o Inn 'r`' e -) c
Owner Mailing Address: ?O • (o c 5 Cl ei -0L+ \ o I d (11( 11 119`7
Owner Property Address: S 1 e `-1 \-ko 1 \ a 019 vn-
ScA -, o I
Name and phone number of contact person S n 61 r A S A-%/okdl 2 3 4 5 Co a 0
Tax Map No: Section -7 g Block I Lot 3 2/
Cross Street (,mss Gv,_) eo r C1 \ i v ~e
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURY WITH
nHEALT DEPARTMENT APPROVAL
1 3G -o (0
Signature of Applicant Ob Date
Received by: C'GA
SURA OF PROPERTY N
SITUATE: SOUTHOLD
TOM: LD W ��- E
SUFFOLK GOUNTY, NY , N
SURVEYED 03-10-04 .. ' S
TOPO 10-05-04, PROP. HSE. 11-22-04 -
REVISED 01-31-2005
EDGE OF 1NETLANDS AS
SUFFOLK COUNTY TAX # DELINEATED AND
I000-1S-I-3S LOCATED BY ROBERT FOX
OF SEA LEVEL MAPPING
CERTIFIED TO:
Joan E.Nixon Land'15tIeInsurance Comlpany G_P, r Focroef\\- \ 'aerf-s
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I k r�oit�pQV �l l well
, \GAO ement i/)e
1 SUFFOL. `- 'tom 'R. 1.,:i A. >:,-,:t,: '" r"\E?ALfH SERVICES
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„ ' FEEING PER �'i' er: ,? o� ',t a I.., .. '",t" ''s UCTIL3IV `
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DATE ( oS- • r • s0. t�I O�� f
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APPROVED
FOR MA,I UM OF BEDROOMS TEST OLE BY
E7CPIRES THREE YEARS FROM DATE OF APPR44iNAL GEOSCIENGE
11/1 /2004
Brown Silty
sand -9.1 2.5
'.`j i
j
[i NOTES:
• MONUMENT FOUND tt l ," `
o PIPE FOUND r ;�a Pale brown
A STAKE FOUND Fine to
med ummop
k mt arlied alteration or addition to a*Levey
d boa-Ing-Ing
g a licensed lend surveyor" teal Is o
SaiI n of
latbsection 1209,sub-division 2,of the
5PSM
Nen York State Education Lan'
Yti
AREA = 40,031 S.F. or O.q2 ACRE , mak copies From the o the l n surveyor's survey
tea.1th t originalof aM land eye S
a stamped seal shall be consdered to t»valid trve
FLOOD ZONE INFORMATION ANNOTATED FROM S,, 0 '' . , GertFcato.o peen man sg ly hatiNs
5 4 wr..ey nos prepaned M accorda,ce with the ex-
.4;code of Practice Far Land S.rveys adopted
FLOOD INSURANCE RATE MAP NUMBER 36I03G0166 G. by the Nen York State Association of Professional
Lard Surveyors Said certifications Nall run only
q{��l to thh person for whom ee ourvey b prepaned
any
govorn
on-
•/ W%�"\ to the Sass behalf
tM lene ding MtU tion.C tlFba-
TOPO ELEVATIONS REFERENCE NGVD '2c1 BENCHMARK tai and lend Institution listed hereon,and
Il' tis are not transferable to additional t,.umtbns
l
PROPERTY ZONE R— 40 JOHN C. EHLERS LAND SURVEYOR
6 EAST MAIN STREET N.Y.S.LIC.NO.50202
GRAPHIC SCALE Itt= 40' RIVERHEAD,N.Y. 11901
369-8288 Fax 369-8287 REF.\\Hp server\d\PROS\04-135.pro
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