HomeMy WebLinkAboutKerbs, Jon I�,i�'�' 0 Are
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ELIZABETH A.NEVILLE ��'O �Gy�`; Town Hall, 53095 Main Road
TOWN CLERK o , P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS �y, Southold, New York 11971
MARRIAGE OFFICER �
O Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER �41,* O�/'�� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER .1'J -I.-
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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. 2150 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JON C. KERBS
Address 1 : 440 RILEY AVENUE
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF # R10-99-9962
Name Of Owner KERBS, JON C
Mailing Address 1 440 RILEY AVENUE
City St Zip MATTITUCK NY 11952
Property Address 1 550 --Rener �.
City St Zip C NY 1.135r--
Tax
5;2Tax Map No. section 54.00 block 6 lot 4.005
Cross Street SOUNDVIEW AVENUE
Building Permit Number Cross Reference:
Issue Date: 10/01/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ,��=Z' G`:� Town Hall, 53095 Main Road
TOWN CLERK % c* - % P.O. Box 1179
%•REGISTRAR OF VITAL STATISTICS •
v. t� Southold, New York 11971
MARRIAGE OFFICER �
O �� Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER �y1f�1 ill
� �/tIs Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER �•' ,e���10-
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FFI E OF THE'TOS" ER
OFFICE
TOWN OF SOUT ' '`r SO m ,
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 13, 1999
Transmitted herewith is a copy of application No. 2236 for a Cesspool/
Septic Tank Construction Permit submitted by:
Jon C. 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.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following reco endations:
APPROVE
DISAPPROVE
Comments:
Signat tt
9 113 iqq
Dated
r
OFFICE OF THE TOWN CLERK ,t'
'��FFO[K
TOWNOFSOUTHOLD ;��� ..(W--. . Application No. - 'c
ELIZABETH A.NEVILLE,TOWN CLERK Construction '''.-----
P.O.BOX 1179 `
SOUTHOLD,NEW YORK 11971
` ofi Alteration
.�
Telephone y0ir %67/ • $10.00 - Residential
(516) 765-1801 -.. 4/ $ ''�'r $25.00 -Non-Residential
• -- ,,..,,.,•o
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE CA v 9 i
APPLICANT NAME: v u . a - kece ,e-P S
APPLICANT ADDRESS: LqO i t(eLi Ave
NL Ek 1 N_ • (0 S 2--
SEPTIC
SEPTIC CESSPOOL
DESCRIPT N OF PROPOSE CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION
OFPPROPERTY ONST�U�T ON O�ALTER�YI,ON
OWNER
OWNER MAILING ADDRESS: l T O ((‘e r
I
",....,AP _
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OWNER PROPERTY ADDRESS: ;if. � �� I "� Ynril i /
7
s5Tsvtalibrio.e. X ��L` • . ,. . v / w1re
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TELEPHONE NUMBER OF CONTACT PERSON: 5 /6 - 76, 9– a 6 5–C.
TAX MAP NO. : Section c 1 Block 6 Lot ci.,g
CROSS STREET: , S vim& \....1\c1/4,..) P"4 e--
BUILDI
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BUILDING PERMIT NUMBER CROSS REFERENCE:
„ 1.ture of App icant
RECEIVED BY : . ��
wn Clerk's Office
DATE: �!
• 'ISUFFOLK COUNTY OEPARTM:iIT OF LTALT II SERVICES l
•
i PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
eiNGLE FAMILY RESI-t%ENCS ONLY
♦ ✓d'p'//ONL L/MOCR Cia<�IT.
'ZE Oi SCI::;404.
�b DATE SEPAO 1999 Hs 0.\ I v-9 Cl�
�FISCNfl,b-'4. APPROVE A/�'� GEg4G
• b .S+ * FOR XAfUM OF_1l3uDi:00IdS
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n. \ `�'rd EXPIRES 1HREE YEARS FROM DATE OF APPROVAL e• h 3
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NOTE CHANGE(, 'TLor NacE Ni o 4 f
LI Dept.of Health$rv��es r, n/o ocAtC j` y V
Nan:s, a All roof runoff to be digpd to drywells . /.7 - tr 4
b. Site shall be graded to contain all runoff on site. . to I", fevo'✓/urydsvoS Y y h
c. During construction of sanitary system,remove all impervious soil within 3 feet L,IL p,^
horizontally Backfillr'.4with clean material r QI I v fja'
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/ / * . ',t- �, EXCAVATION:'J$'cCTICr:J REQUIRED
I i=OR SANI'i RY SYE TEM
4,0,-,1 LIY FIEALTII :PAPTMENT
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