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ELIZABETH A.NEVILLE �O �y � Town Hall, 53095 Main Road
TOWN CLERK < P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ti rpt
Z Southold, New York 11971
MARRIAGE OFFICER �� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER ` y �� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ���� �a���'
y''••.. ����
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2210 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : STONERIDGE CONTRACTING
Address 1 : PO BOX 229
City St Zip MILLER PLACE NY 11764
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 #R10-99-0211
Name Of Owner JACOBS, STEPHEN
Mailing Address 1 PO BOX 229
City St Zip MILLER PLACE NY 11764
Property Address 1 MEADOW BEACH LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 17 lot 17.025
Cross Street NEW SUFFOLK AVENUE
Building Permit Number Cross Reference:
Issue Date: 12/28/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
o
o�
ELIZABETH A.NEVILLE $ti`1` Gym Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS . rft't Southold, New York 11971
v
MARRIAGE OFFICER � Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER `�y�� �0.11� Telephone (516) 765-1800 i(
FREEDOM OF INFORMATION OFFICER 1,11
..••... tis
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 16, 1999
Transmitted herewith is a copy of application No. 2298 for a Cesspool/
Septic Tank Construction Permit submitted by:
Stoneridge Contracting & Interiors Inc. for Stephen Jacobs •
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.
*---x
Linda J. Cooper
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments:
Signatu
liilq9
Dated
OFFICE OF THE TOWN CLERK ',!'��`F��K`►''
TOWN OF SOUTHOLD �.'.Q ` �1 QG Application No. 2,?.. U
FI WABETH A.NEV111 F,TOWN CLERK i O r%
P.O.BOX 1179 •� Construction
SOUTHOLD,NEW YORK 11971 . O 'T
trs Alteration
Telephone D,y iri $10.00 - Residential
(516) 765-1801 - Ol 1i� �'� $25.00 -Non-Residential
-,�.o�,
r;
TOWN OF SOUTHOLD s'
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT C`
SEPTIC TANK or CESSPOOL
Permit No.
-
Fee $
DATE 7ctrr i6E12 i3, t11 ?
APPLICANT NAME: -Crtt,vf(Z1b6aivI1c ,c-r; .r T,r-,8rc,eix,5 )c •
APPLICANT ADDRESS: P,9 • Qoic aa_q
r-1\; PAC NY i D 6/
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Sots-a .•.,m,Ly "bidiTu /1/6-
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Srep,ta,s, -TA co6S
OWNER MAILING ADDRESS: P�. 3 euq Cla-•Le2 Pace Os/ 11-) Of
OWNER PROPERTY ADDRESS: (v)go,...) & pc '.pave
irkyrT'f ITuC►C
TELEPHONE NUMBER OF CONTACT PERSON: 331- 1 SS t`
TAX MAP NO. : Section IIS Block 1l Lot 11,
CROSS STREET: I' lEv1 SufFoi,l& Pape'.
BUILDING PERMIT NUMBER CROSS REFERENCE:
(4411-744,0- ' -'445‘....T .,‘
Signature of Applicant
RECEIVED BY : F___S
Town er ' Office
DATE: /
7:74._.5"
41Water lines +lust be inspected by the
o Suffolk ice.unty Dept.of Health Services. o &II
Cali 852-2100, 24 hours in advance, g.
fVIIung to schedule inspection(s). Young & Young, Land Surveyors iii
I yam. .. - 400 Ostrander Avenue, Riverhead, New York 11901
�IInn� Watet li... :I r;, i the 516-727-2303 a:!
�� ,rices. -.
Suffolk C' .-n - Alden W. Young, P.E. & L.S. (1908-1994)
Ca11852-21 QQ,to hours dl i ��`�d11ce, Howard N, Young, Land Surveyor
Pluming Thomas C. Motpert, Professional Engineer o
1 tO schedule inspection(s). John Schnurr, Land Surveyor
; ;
•rw
•ncurying UE F- _ — NOTE -- il
`�
AVEN — ib3
SUFFOLK pAVEMEN' = AREA = 42570 S0. FT. ,_
EDGE ✓ 6J_
NEW 200.00_ , _
01v;-
.e
cc.). 2• ADE HLCC1 r _-- SUFFOLK COUNTY ON AUG. 21, 1987 AS MAP NO. 8377
N83'11'30"E NT FDR e
\` �_-- _���cc cYY ,z EASEME • VERTICAL DATUM = N.G.V. DATUM (M.S.L. 1929)
` r-22.0 - s 0 WATER MA,N a�
O
---\\--
/ E _ - GE oc �F�
E° O) • ELEVATIONS SHOWN HEREON MAY BE FROM MAPS OR SURVEYS gig:
/ ,� > PREPARED BY OTHERS AND ARE SUBJECT TO FIELD VERIFICATION.
WATER E
J EASEMENT CO.
VAVLE / R�4 DRAINAGE E GE03) Z^
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itE TE
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jjc�+` rn fl'
V€` bkiDgp�.0HSE1wDDDE a -
; \ \ .49
LoT 40 io.Q= sv5'rpa 10WO - . ` ,`i $ 'l,r 09, ,1H (VACANT)
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zoo' FRC T[ RADIUS — i\ PSA+�Y F.-'111''1 JOHN SCHNURR, N.Y.S. L.S. N0. 49517 G Z01
i /HOWARDW. YOUNGLS. NO. 458932\ ` ,0ff` a
o '�ZN. ��°S SURVEY FOR '' OF
0
��� • "w E.04' STEPHEN JACOBS & SUSAN JACOBS
`gz,o 56a , LOT 39 "HARBOR VIEW AT MATTITUCK"
\\: \ ° -58 Woe,) At Mattituck, Town of Southold sf
w c'''atsc Ps°`'` _ _ _ Suffolk County, New York a-E
\ \� l,,,cc - ~' �� 1' CiS r County lox Mop Detract 1000 section 115 elan 17 0,17.25 8
E \ s°�i•c� f L 1 it t .:TO ! Ii :itiJ:
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P
y y F".,;;:v' ' ): F ifII aoRA BUILDING PERMIT PLOT PLAN „°t
/ . -*i uQ';!, 1 r 1 r '?pEd'•(:.s:,tdY e
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's; DATE ig771ia ',:-.:...‘,71,1,-15,„)D
,1� )D -/9 Odl1 o
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MAP PREPARED SEPT. 15, 1999 = E
0-MONUMENT SEi -MONUMENT FWND A STAKE SEi A STAKE FpUND Enures ima.-- .TARS FC_'V DAIL X11 APPROVAL SCALE 1" = 50 9Q.•
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nO• JOB NO. 99-0557 1 OF 1b
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1 -- DWG. N0. 990557 O