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ELIZABETH A. NEVILLE $, GZ�; Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �. Southold, New York 11971
MARRIAGE OFFICER 1Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER =411f0 a��,.11 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER :�1 * ����
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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. 2240 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : CHRISTOPHER MOHR
Address 1 : 520 CLEARVIEW AVENUE
City St Zip SOUTHOLD NY 11971
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 #R10-00-0012
Name Of Owner MOHR, CHRISTOPHER
Mailing Address 1 520 CLEARVIEW AVENUE
City St Zip SOUTHOLD NY 11971
Property Address 1 1425 JACOBS LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 6 lot 4.004
Cross Street MAIN BAYVIEW AVENUE
Building Permit Number Cross Reference:
Issue Date: 2/08/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ppr
2 )\0
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ELIZABETH A.NEVILLE 1'�_'� GZ� Town Hall, 53095 Main Road
TOWN CLERK
o - % P.O. Box 1179
k ca Z ' Southold New York 11971
REGISTRAR OF VITAL STATISTICS % '
MARRIAGE OFFICER % O 'V 0 Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER ' ' 01 .02, 0.-1 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
"ee___ Os.1
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 2, 2000
Transmitted herewith is a copy of application No. 2328 for a Cesspool/
Septic Tank Construction Permit submitted by:
Christopher Mohr •
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.
Vr(- 14—d-e--<---
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following 9ecommendations:
..;/'
APPROVE
DISAPPROVE
Comments:
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Dated
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OFFICE OF THE TOWN CLERK ,,'���FFU[K
TOWN OF SOUTHOLD � CSG" Application No
ELIZABETH A.NEVILLE,TOWN CLERK /
P.O.BOX 1179 : FD Construction
SOUTHOLD,NEW YORK 11971 v rn
Alteration
TelephoneO,� �Q�'�' $10.00 - Residential
(516) 765-1801 Olifir� ��'� $25.00 -Non-Residential
•
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE p� 0 0
APPLICANT NAME: C/f ( S TaphiKL �2 m OJ/)
APPLICANT ADDRESS: S?6 ('llIlnvlrw JAI-/ (
scludh,1d
SEPTIC CESSPOOL )(
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
11(o) 11011 c
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: rh-(sX,04,4 /C 1 'l li,(
OWNER MAILING ADDRESS: 52v (lt4.'vltcc) {-' C
I/ G-11
OWNER PROPERTY ADDRESS: it'y�(�/ S ttf(
covnie)d` It•J Y
TELEPHONE NUMBER OF CONTACT PERSON: (H,z is p✓(olot
TAX MAP NO. : Section /600 Block 7 Lot Q 6 — C-/ Y
CROSS STREET: M G Ik /5G7v7«„J
BUILDING PERMIT NUMBER CROSS REFERENCE:
ignature of Applicant
RECEIVED BY :
Town C rk's Ice
DATE:
fi
SURVEY OF
CERTIFIED TO: LOT 4 '
s FIDELITY NATIONAL TITLE INSURANCE COMPANY OF NEW YORK
6 THE SUFFOLK COUNTY NATIONAL BANK MAP OF
co Ao 3S, CHRIS MOHR
L-7 �k m 0,, ROBERT T. N CROWT�F,Y ESTATES
w4'V c ' ar F FILE No. 8236 FILER DECEMBER 12, 1986
�1��_ SITUATED AT
3 �-- BAYVIEW
� a
---- �.,....1:... TOWN OF SOUL OLD
J SUFFOLK COUNTY, NEW YORK
j J S.C. TAX No. 1000-79-06-4.4
•RTS SCALE 1"=50'
co B
-14 tt>>T � JULY 29, 1998
pso "�, .1V j, /r DECEMBER 22, 1999 ADDED PROPOSED HOUSE & B.O.H. DATA
°\4p_2 p LOT '+ ROA AREA = 104.448.51 sq. ft.
3��) k�F<</� "� 2.352 ac.
A° I' r
i 40
4
_ 42
1
R.
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20, •
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NOTES: ,� �M
1. ELEVATIONS ARE REFERENCED TO AN ASSUMED DATUM .....?o.,.
+ -
...'-4o,EXISTING ELEVATIONS ARE SHOWN THUS:_1110 - '. I' .. III
��
2. REFER TO FILED MAP FOR TEST HOLE DATA. ` ,:;be r ► ;
3. MINIMUM SEPTIC TANK CAPACITIES FOR A 1 TO 4 BEDROOM HOUSE IS 1,000 GALLONS.
I TANK; 6' LONG, 4'-3- WIDE. 6'-7' DEEP *4t:-1.:•:..
/ /�
4. MINIMUM LEACHING SYSTEM FOR A 1 TO 4 BEDROOM HOUSE IS 300 sq ft SIDEWALL AREA. LOT
I POOL; 12' DEEP, 8' dlo. D'E` O ., 1- // J
PROPOSED EXPANSION POOL <</NC a / '•
/
PROPOSED LEACHING POOL ��t.r1['•k-�/
Ma PROPOSED SEPTIC TANK ` y� ,t' t:4?TIT { - •. - .
S. THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD ° • - s ..��` •
OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. / •C3 '
4C 42F4
PREP 4e• ,..:41 . WITH THE MINIMUM "Q( /` �a0 -ri:v' Q �� .1� f i '
''' \
• ';;o15. ABUSHED
.,., �,+'4,A,,, „ KAS FSSATAD�LAN .. � ✓ ryV' moi .- N, �J .. r
----42 r n.g.:'.4'.
-`DV 4p
i 46 Joseph A. +e�!, - 1 ( - -c--,..,,,• .\\�c \ lN1Al11HORIZED ALTERATION OR ADOMON ^ C
/ C.^ �: TO THIS SAW(1S A VIOLATION OF / -`/, • •�•..,v ""�'� �..,,�,
Land Surveyor F - � SECIION 72W OF THE NEW YORK STATE ss 1�0 �(y\ r' . ...
y 1 i Y� ,_ U c !'�
EDUCATION LAW.
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"� 1 EMBOSSEDIIND�i IqT it C016DERED , 1 '` t..;, - _
Title Surveys - Subdivisions - Site Plans - Construction Layout , r. '14414t k,•,/j TO 8E A WLO 1RUE COPY. C444M1, Y y: tj r.!3�OT,A=' E ,
CERTIFICATIH( H10�DIN SOU.RUN \.-\ $ 0
PHONE (516)727-2090 Fox (516)722-5093 ..- a Y TO11 FORWNW TOT THE Y 1I , ' — -- ---
iBLi AND /
OFFICES LOCATED Al SWUNG ADDRESS N.Y.S. Lic. No. 49668 THE rausrmcc or okto or WAYS
T107N0 q WIE OF AND/ON pW IF
One Union Square P.O. Box 1931 T1moN. ma�n� ANY. NOT SWATH ME NOT e0it71RANtlED• / D +
Aquebogiw. Nee Yak 11931 Rivertleod, New York 11901
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