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Home My WebLink AboutJacobs, Sharonr ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER C= til y x OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-6145 Telephone (516) 765-1800 Permit No. 2114 R Residential X Non -Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : SHARON JACOBS Address 1: PO BOX 585 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 #1110-99-0124 Name Of Owner JACOBS, SHARON S JAMES ------------------------------ Mailing Address 1 PO BOX 585 ------------------------------ ------------------------------ City St Zip MATTITUCK NY 11952 -------------------- -- ---------- Property Address 1 COX NECK ROAD ------------------------------ ------------------------------ City St Zip MATTITUCK NY 11952 -------------------- ------------ Tax Map No. section 113.00 block 12 lot 10.002 Cross Street ROUTE 48 ------------------------------ Building Permit Number Cross Reference: Issue Date: 7/09/99 ---------------------------------- Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: July 7, 1999 airy Town Hall, 53095 Main Road P.O. BOX 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 Transmitted herewith is a copy of application No. 2202 for a Cesspool/ Septic Tank Construction Permit submitted by: Sharon M. 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. Linda J. Coope .y I have reviewed the application and location map of the project cited above and make the followingrec mmendations APPROVE � DISAPPROVE Comments: gnat U 1 ( ci Dated o ti - Z OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: July 7, 1999 airy Town Hall, 53095 Main Road P.O. BOX 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 Transmitted herewith is a copy of application No. 2202 for a Cesspool/ Septic Tank Construction Permit submitted by: Sharon M. 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. Linda J. Coope .y I have reviewed the application and location map of the project cited above and make the followingrec mmendations APPROVE � DISAPPROVE Comments: gnat U 1 ( ci Dated OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD ELIZABETH A. NEVILLE, TOWN CLERK P.O. BOX 1179 SOUTHOLD, NEW YORK 11971 Telephone (516) 765-1801 Permit No. o��FFo�K�oGy TOWN OF SOUTHOLD Application No. 0),40 h Construction ;,.� Alteration $10.00 -Residential 6.,-- $25.00 - Non -Residential_ SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Fee $ DATE -71-7 APPLICANT NAME: �J412C»1 (Y) • t._JI�CG,S APPLICANT ADDRESS: SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION l A.) H -D t") � LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY:- Jlolrye 5 -r 5 M J�) CU%S OWNER MAILING ADDRESS: POP) -rVs (Va-7 1zix_* OWNER PROPERTY ADDRESS: F r Tf}C:.c>35 TELEPHONE NUMBER OF CONTACT PERSON: -7 (� S - L- 96 [o L,) cI &S 1-h li liuTO TAX MAP NO.: Section Block 1, Lot 0• CROSS STREET: BUILDING PERMIT NUMBER CROSS REFERENCE: �zun h rw ng - ix—cz�� Sig -nature of pplicant RECEIVED BY: I z C"- Townerk's Office DATE: `7� Z i I TEST HOLE from filed mop 0.0, Loon 4.7' 17' CERTIFIED TO: JAME5 H. JAGOB5 SHARON M. JAGOB5 R05LYN 5AV I N65 BANK NOTE5: R 2RO N8 0°00, j, o I— o- jl� 1 �1. m Lot # 3 F,a � 20 Iran yo: � oty� o` 0 V ?65.63 PLEA/SE NATE Minimum distance between ell and cesspool is to be 150 feet. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT FOR APPROVAL. OF CONSTRUCTION FOR A o E FAMILY RESIDENCE ONLY DATE F 0. R�0-7q-012 APPROVED FOR NtAXIMOM OF * B DR OMS EXPIRES THREE YEARS FROM DATE OF APPROVAL �Q�p'i`N C. Ey0 r � '��tis N�• 5022 J LA N D SUP Sg7a16, W 293 78, ■ MONUMENT FOUND 0 PIPF FOUND AREA = a8,30 5F OR 2.26 AGRFS JOHN C. EHLERS LA. GRAPHIC SCALE I"= 60' 6 EAST MAIN STREET ---- _--_. RIVERHEAD,N.Y. 11901 _- 369-8288 Fax 369-8287