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HomeMy WebLinkAboutGomez, Cecilia ,o��gUfFO�,�co ELIZABETH A. NEVILLE ����� 'y ; Town Hall, 53095 Main Road TOWN CLERK h - P.O. Box 1179 REGISTRAR OF VITAL STATISTICS � ,,'1i Southold, New York 11971 : MARRIAGE OFFICER ,L Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER *a��iii Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER .9 ,,,i OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 2229 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : BARRY NOVICK Address 1 : C/O C. MESIANO City St Zip EAST MORICHES NY 11940 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 #R10-99-0251 Name Of Owner GOMEZ, CECELIA Mailing Address 1 123 COVE POINT City St Zip LUSBY MD 0000 Property Address 1 695 TOWN HARBOR LANE City St Zip SOUTHOLD NY 11971 Tax Map No. section 63.00 block 4 lot 9.000 Cross Street L'HOMMEDIEU LANE Building Permit Number Cross Reference: Issue Date: 1/26/00 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) .. as aA 4;-- EIZABETH A.NEVILLE 4. : Town Hall,53095 Main Road TOWN CLERK , o , - % P.O.Box 1179 REGISTRAR OF VITAL STATISTICS v. �$ Southold, New York 11971 MARRIAGE OFFICER : V/� Fax(516) 765-6145 RECORDS MANAGEMENT OFFICER -y�,Ja�����1 Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER '� * 0 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: January 18, 2000 Transmitted herewith is a copy of application No. 2317 for a Cesspool/ . Septic Tank Construction Permit submitted by: Cecelia Gomez by Catherine Novick 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 rec endations: APPROVE DISAPPROVE Comments: ..- Signature l (I Me Dated 4. ,,,,,,,,,,��,: OFFICE OF THE TOWN CLERK , ��' ,,FO //��� TOWN OF SOUTHOLD eee 4Q Application No.� ELIZABETH A.NEW I P.TOWN CLERK OA P.O.BOX 1179 Construction v SOUTHOLD,NEW YORK 11971 C=7 Alteration Telephone OA, $10.00$10.00 -Residential �- (516) 765-1801 = l 1 ��'� $25.00 -Non-Residential • TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ DATE I i$ /000 APPLICANT NAME: ?t1-ti,y 1\10V IGS APPLICANT ADDRESS: CIo L� rir e ut,44 12 MO! V L. f. riloft c.i N y 1194-0 SEPTIC •l' CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION 5 2 't cos ' 'It stf V�m./ CI LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: Ce cc] t .. �U me•x.- OWNER MAILING ADDRESS: 12 3 Csvc f f L illy Mb OWNER PROPERTY ADDRESS: (p '5 5ctcr-rH40t TELEPHONE NUMBER OF CONTACT PERSON: C. I Y M► c'Slc� ;�c RT8` 'g`) 51 TAX MAP NO. : Section (03 Block <{ Lot CROSS STREET: Lkfvrn-tw L, L- _ BUILDING PERMIT NUMBER CROSS REFERENCE: ()CU/C44.. • /9/1-“A-4;4-6 'signature of Applicant RECEIVED BY: /6'7 /4(-4--"4 Town Clerk's Office DATE: • SURVEY OF PROPERTY �- SITU ATE: SOUTHOLD V'}FOLKCOL323Te DEN-mmi 0:'is \*-;;.;24:.- :;i a w•T5 \o , Li TOWN OF SOUTHOLD ) 1 FIRYrr tr+.:tip > ,i - }z,. .rcxi F-0.•:,.i, ��q 1 SUFFOLK GOUNTY, NY 0\'L ' a-. �h ti�o SURVEYED 12-01-AR APPROVED,. ,L& // = ' �Q SUFFOLK COUNTY TAX Tt...; A,$h ._ .\ Oi•�SrfiOVP!. ({ "),,L,;',9 �J Q G� SUFFOLK -63-4-Q FOR.2.: P.' OINCS �, .. L R. D S CERTIFIED TO: °�(�`0ti'O\,�C� BARRY NOVIGK °t F����° • j� GOMt10NWEALTH LAND TITLE v'. �' \��' INSURANCE COMPANY <`�\\�P PJ\0 'J� lQs 50 °\ TEST HOLE 4,� ,,,°a ,'.o 11-30-6L 4") °a 6cs 0,,,c/o) '''c.% L oP° Q 49') /(jG�z� Ped , QC Qj SEPTIC- DETAIL ‹) not to scale y ,ss •,- t \.. t aD-.___ \ 0, '.)6‘4 3 , NOTES: r/�✓� ©© qj t°.°\^ GP'� of NEIy_ �� .(-‘0�aL '�� • fr0 • MONUMENT FOUND �P V i�h�..e, 9�` ..< .....:«......:.. O PIPE FOUND __..):: HEDGE '}tp}� M ,* a'a:.�F.;,r ¢' ,,.q..,..�.«��>.�..,«...,.« ...�. . • .-. WIRE FENCE 11 Ed 17 IED J� °Fti '/b.b At. AREA = II,021 5F OR 02"1 ACRES +1 8F�LAND S;�P,/' DEC 7 1998 q „M�.�., , .:. ELEVATIONS REFERENCE SUFFOLK C JOHN C. EHLERS LAND SURVEYO} COUNTY TOPO MAPS .71Suffolk Co.Dept of Health Servioec 6 EAST MAIN STREET N.Y.S.LIC.NO.5020: GRAPHIC- Environmental 1"= 30' Enviraental Protection R 9-828 EAD,N.Y.11901 369-8288 Fax 369-8287 REF.-TIGER\PROS\99-2•