HomeMy WebLinkAboutCockerill, Robert (2) 000
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ELIZABETH A. NEVILLE t$h`1` yam►`` Town Hall, 53095 Main Road
TOWN CLERK :'� , P.O. Box 1179
= Southold, New York 11971
REGISTRAR OF VITAL STATISTICS v� T I
MARRIAGE OFFICER O Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER ` 411* a�
O�,�� 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. 2108 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ROBERT & MARIA COCKERILL
Address 1 : PO BOX 1835
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 #R10-97-0134
Name Of Owner COCKERILL, ROBERT & MARIA
Mailing Address 1 PO BOX 1835
City St Zip SOUTHOLD NY 11971
Property Address 1 RAMBLER ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 88.00 block 5 lot 22.000
Cross Street MAIN BAYV I EW ROAD
Building Permit Number Cross Reference:
Issue Date: 7/06/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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4ELIZABETH A. NEVILLE I Town Hall, 53095 Main Road
TOWN CLERK p '� P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v Southold, New York 11971
MARRIAGE OFFICER
O 4 Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER -�y�fQ 40111 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER '1 *
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 25, 1999
Transmitted herewith is a copy of application No. 2196 for a Cesspool/
Septic Tank Construction Permit submitted by:
Robert and Maria Cockerill .
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 re ommendations:
APPROVE
DISAPPROVE
Comments:
ignat
Ct
Dated
OFFICE OF THE TOWN CLERK • FOL4'
TOWN OF SOUTHOLD �/' Application No.
} ELIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971
$25.00 - Non-Residential
Telephone TO 0 '
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION JUN 25 1999
for
COUrhgown ClCleric ,u( QJ0
aapERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 6-/-7-479e
OWNER NAME: fg17bed a „/G'GJ^JCc- 6rickr/// _
OWNER MAILING ADDRESS: / t9.
(21)11.10) d //°17/
L
OWNER PROPERTY ADDRESS: ,5-4-//2 KJlt/1144y- rd
5001-hold 4/ //q1 /
OWNER TELEPHONE NUMBER: ,57 74s 5 ?
TAX MAP NO. : Section 66 Block QJ Lot 22-
CROSS STREET: i'' /p2 6a1/1�.° (A)
TYPE OF SYSTEM: Septic Tank (J�/ New t/ Existing
Cesspool New V Existing
Residential L Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
4C/4(4 &elaXiek
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
62/2---
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SCDHS REF NO. R10-97-0134
V Lt. r
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION
�\ y �Q - OF SECTION 7209 OF THE AEW YORK STATE EDUCATION LAW, "!
6 o EXCEPT AS PER SECTION 7209 S(J90/VISAON P. ALL CERTFKATIONS
O HEREON ARE VALID FOR THS AIAP AAV COPES THEREOF ONLY F
CI
SAD APAP OR COPES BEAR TIE AHPRESSED SEAL OF THE S(EVEYOR
� O WHOSE SIGNATURE APPEARS IEREOK
ADDITIONALLY TO COMPLY WITH SAID LAW THE TERM 'ALTERED BY'
' �' 6Q' MUST BE USED BY ANY AND ALL SURVEYORS UTAIZING A COPY
00 �`� SS02 I� w, WROUGHT-TO-DATE'OF ANOTHER YARE NOT It COMPLIANCE WITMAP. TERMS SUCH ASH LAW.
D'AND
\ l FO �Y�c/ A/ e'qY
��' \ _ `/F/y The I. .ti. s�oo�ff wells and cess,00lls R
e,-, �! �0 shoshow, hf from ppt *.l e _d S :'t�/h!C PilE 1.T*t SER VICES
J. \ !v APPROVAL OF CONSTRUCTED WW'OF KS Irf:A
A SINGLE F AI•ittt'L f 5'1F;F�L
�� 0/ Date j,ILS.ReC No. / '/i ?. 1/�j7
5is The sewage disposal and wort supply taciliric-qt this toes Ion have been
\9 �, t�\,�o"t rb 4 tmpocted anOito oertifiud by this D-rr rtric e•: ner agencies and found W
�q lr 39 Ur ,ire4;r4,
./�'`,3.
. . '�{` ar be satisfactory FOR _L4 .1t0M OF rE,D t .
• e` \Q �t r �� 36) kh ...:F. ��a. L t.
4'•S T. -.I CII h.;:Gift,'-::..Citic;
\ 're. - / Oma of ai Y and wr cr`Azi agement
00 _,. X51 as yd
r ss. \ 4612 `�`�� e' SURVEY OF
1t. 0.
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�.1 o ti� LOT 31
\ tiz'4 1/ �� "MAP OF TERRY WATERS"
,.% e, a 4y// _____Ap, Q FILE MAP NO. 2901 FLED DEC. 29, 1958
TEST HOLE y. q AT SOUTHOLD
aearry
43ii
LOAAIY kiCDt TOWN OF SOUTHOLD
sirz' e ^► o ti SUFFOLK COUNTY, N. Y.
o� P ��� 1ti V� ���" 1000 - 88- 05 -22
L e9.
h
DROWN FINE 4)a 4 ,o 1g° SCALE' , =30'
ro COARSE 620 SW
A `\ `Y P' JULY 14, 1997
�� CONC. Q. f APRs[ 6, 1898 ( foti dation I
WWI�t Fro tiae SEPT 30, 1998 (final)
/ s\ ,
rs•
WATER N „f cart . of
CERTIFIED TO
APE
ro COARSE —/ War' COMMONWEALTH LAND TITLE
Sano SW I am familiar with the STANDARDS FOR APPROVAL 6a INSURANCE COMPANY c0 NEW Yp
AND r7
DISPOSAL SYSTEMS FOR SINGLETRUCTION OF FACE SEWAGE FAMILY RESIDENCES A� c., ,,,fit.MEi?Qp,
and will abide by the conditions set forth therein and on the 'o g. r`., ,4c
10.F :-,r
permit to construct. r� <_' �,;,. 1
d��a�Ij� &1(PN.Y. NO. 496/8
AREA = 17,513 sq. ft. -EcoNi :i0#;,474-4".%..s 7
15I F) 765 UM-