HomeMy WebLinkAboutRogers, Robert SCUTHCLD WISTEVWTER D SPCGAL PERM T
CCN TR ETI CN CR ALTERATI CN PERM T
SEPTI C TANK or CESSPCCL
Per m t Nb. 4206 R R si dent i al X Nbn-Fbsi dent i al
Fee $ 10. 00 Septic X Cesspool
PERM T I SSIJED TO
Name : ROBERT & MALEEEN RCS
Addr ess 1: 221 MATERS EDGE DRIVE
Q t y St Zi p TC1v6 R! VER NU 08753
Descr i pt on of Proposed Const r uct i on or AI t er at i on
SAN TARP SYSTEM FCR SI NCLE FAM LY DiELLI NG
APPROJED AS SLBM TTED AND AS APPROiED BY TI-E SIFFCLK CCLNTY DEPARTMENT
CF I-EALTH SERA CES. Fl NAL APPRO✓AL REC.0 RED FRAM TIE SIFFCLK CCUVTY
HEALTH DEPARTNEJVT. REF #R10- 13-0010
Narre Cf 0,ner ROBERT & MIEN ROCERS
Mei I i ng Address 1 221 MATER ECCE DRI VE
Qty St Zip TONS RI VER NJ 8753
Property Addr ess 1 555 SLM1 T LADE
Ci t y St Zi p EAST Km CN W 11939
Tax Miip Nb. sect i on 35. 00 bI ock 8 I of 50. 021
Cx oss St r eet MaRI NA LADE
Bui I di ng Perm t Number Cr oss Ref er ence:
I ssue Det e: 4/07/ 14 El i zabet h A Nevi I I e
Sout hold Tow, a er k
jig,
,I�,,O��gUFFO(, �0
ELIZABETH A.NEVILLE,MMC ��0 G.y N Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
t C13 at t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS `W ��
O � � Fax(631)765-6145
MARRIAGE OFFICER ',* 0.,11 Telephone(631)765-1800
RECORDS AGEMENT OFFICER FREEDOM OF INFORMATION OFFICER O!Ai„I", O. www.southoldtownny.gov
OFFICE OF THE TOWN CLERK i; ,� r 11
TOWN OF SOUTHOLD (" ' "
r! .
1 C [i MAR 1 8 2013 i,';,
TO: Southold Town Building Department
I t
FROM: Carol Hydell, Southold Town Clerk's Office Trni n
DATED: March 15, 2013
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4206 for a Cesspool/Septic Tank Construction
Permit submitted by:
Robert& Maureen Rogers .
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me. Thank you.
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
r�
Signature 4
O3 �/73'
Dated
,,,,,,,,,,,,,,,
,go,,
ELIZABETH A.NEVILLE i�h� �` Town Hall, 53095 Main Road
TOWN CLERK % p Gy P.O. Box 1179
REGISTRAR OF VITAL STATISTICS W Southold, New York 11971
MARRIAGE OFFICER : G Fax 1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =4:* a,Olii� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER =_'� � 1' 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. �'f'
Permit No.
Applicant Name RO kff Rom Maureen Rog
Applicant Mailing Address .gb2/ Wafers Ldge Drive
Toms River) MT 0816
Septic Tank V or Cesspool
Brief Description of Proposed Construction or Alteration C 051rUcf- !/1 ct.0 / 000 cai,
S tic- -@nft and f0vo(29 8' dlu. /0� 671 e1- depA /eac it p00/5
Location of Proposed Construction/Alteration:
Owner of Property: R0loe/F ROclev`- l`2 a "reen koc)err s / Cor rad Veto ee
Owner Mailing Address: 2 2/ Wal-er-s Edge .prove
Toms River) /J1 o8753
Owner Property Address: 66-6- Stionnref Lane
L crsf- t /arl'on) Al Y 1193 9
Name and phone number of contact person ThOrma 5 C, (A/o/pa+, P. C, % uo15 1---Y1//)5
Tax Map No: /000 Section 35' Block 8 Lot S -( 3l-?a7-
2303
Cross Street 11/41 ar/ioa Lope-
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
,14m1/
Sign ture of Applicant ( Date
Received by: 4► 1100 App l t c )
I,
/ Fouls
• • NOTE Young & Young ;a
400 Ostrander Avenue, Riverhead, New York 11901 €fig;
/ AREA = 37,111 SO. FT. 631-727-2303 �e
• SUBDIVISION MAP SUMMIT ESTATES, SECTION 2" FILED IN Howard W. Young, Land Surveyor -
N Lot 1 I THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON MAY Thomas C. Wo/pert, Professional Engineer P.'8
/
Subdivision - / 21, 2002 AS FILE NO. 10768. Douglas E. Adams, Plessional Engineer gag
"Summit _isEstates, Section 2" / • VERTICAL DATUM = N.G.V. DATUM (M.S.L. 112q) €� o
Robert C. TaArchitect
fl---ki (Dwelling W/ Public Water)
w �- EP,a. , HEALTH DEPATMENT USE g o g
SUFFOLK COUNTY Y D PARTT OF HEALTH SERVICES a�bo
.. <�\ APPROVAL QCONSTRUCTION FORA <z
SFo�
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cc�j` ,0„._.. \So d• ';'' ,,�0 °`\ `\\ 4.0' County Tax Map oIstnctIOOO section 55 BiookOB i..ot 5.21 FFg
^J O •� `J`� \`\ ,,'' ,/',\! \ �� �' \Q \� GRAVEL SAND 4 EUILPIN6 PERMIT SURVEY or a
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0 0= MONUMENT SET • = MONUMENT FOUND A = STAKE SET A- STAKE FOUND \\ JOB NO. 2013-0016 I OF 3
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