HomeMy WebLinkAboutMiller, James Jr 1
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ELIZABETH A.NEVILLE �O l/y Town Hall, 53095 Main Road
TOWN CLERK = c 1 ,� P.O. Box 1179
N = Southold, New York 11971
REGISTRAR OF VITAL STATISTICS v.
MARRIAGE OFFICER %0 ** Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER ��O�r Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER l
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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. 2124 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JAMES MILLER JR
Address 1 : 677 HERRICKS LANE
City St Zip RIVERHEAD NY 11901
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 #R10-99-0017
Name Of Owner MILLER JR, JAMES
Mailing Address 1 677 HERRICKS LANE
City St Zip RIVERHEAD NY 11901
Property Address 1 ARBOR LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 121 .00 block 1 lot 1 .011
Cross Street BERGAN LANE
Building Permit Number Cross Reference:
Issue Date: 3/22/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE y��.Z� ol/y Town Hall, 53095 Main Road
TOWN CLERK = 1 P.O. Box 1179
ti Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS . rr,MARRIAGE OFFICER Fax (516) 765-1823
Oy 0 �O. Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
1
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: March 19, 1999
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Transmitted herewith is a copy of application No. -21:23 for a Cesspool/
Septic Tank Construction Permit submitted by:
James Miller Jr. .
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 mmendations:
APPROVE
DISAPPROVE
Comments:
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OFFICE OF THE TOWN CLERK ,1''' Utir /
TOWN OF SOUTHOLD Le0 )
� � CSG Application No.oZ c2ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 Construction ✓
Iti
SOUTHOLD,NEW YORK 11971 `
Alteration
Telephone Oaf' ire° $10.00 - Residential ✓
(516) 765-1801 _ ,''t• $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 Actk . / . /e7 l r�
q
APPLICANT NAME: , c-t 1e.S Ilt//ef 3-1
APPLICANT ADDRESS: (0 127 1)e6ri eks Awe_ 'lot" gectd M-'r-
) ) 1 1
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
&w ) icatcK 1 i J--)00-t e_ . Res 14sato
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: JCcwte Aline r
OWNER MAILING ADDRESS: (,, PT) )e ('r le,c.S L41,0€ -
1 1 Ut,r I-1 e&,( c1.. Lti )) d 01
OWNER PROPERTY ADDRESS: ()f )J@ 1f ,Gawp /'1a f11 G7LAe k t�1 T of I
TELEPHONE NUMBER OF CONTACT PERSON: J69- 7,2 - )4 0 H°1
TAX MAP NO. : Section 1,9 I - 00 BlockQ/, Q 0 Lot 00 ) . 0 1 1
CROSS STREET: t,`Crl AtV 1-aSA)e .
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applic nt
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RECEIVED BY: U11-/M"-------
wn
Clerk's Office
DATE: 5 1/ 7/ff
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
TEST BORING
PERMIT FOR APPROVA1 OF CONSTRUCTION FOR A
alNGLE F AML_'RI:SID-NCE ONLY
91say-./.0 gamey 1.0.0+ DATE 3-0'-qq • - O. (R\o e,-—00(.7
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�,oy APPROVED \ ' ���— AL
0:11.-.o.X3.0' FOR mAxi UM OF 6 BEI.MS
bRAAALL'
Soon 1 EXPIRES THREE YEARS FROM DATE OF APPROVAL
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Q s. ,� uMinimum distance between well
E4... / s1;, o zdnd cesspool is to be 150 feet.
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TOWN OF:SOUTHOLD DOWN CF SUFFOLK,N.Y.
UNAUTHORIZED ALTERATICN OR ADOTON TO TAS SURVEY ISA ��1Y , as x ;.+ 'F NAP O MAP OF:TKo2A1T01.1 51M1111-41Gt
SEL OM 2
VIOLATIONED
of SECTION 7209 OF TIE NEW YORK STATE UCA• a 7 21,
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TION LAW. H
COPIES OF Tors 91RVEY MAP NOT BEARING TE LAND SuIVEK+'S CERTIFIED TO
WARD SEAL OR BMBOSSED SEAL smAL NOT EE CON:iDEHED 10 M1R 17 1999, FIDELIT(WATIANALTITLE_COMPALly
BE A VALID TRUE COPY. ren CBNVIGGB :NO2?H FOiat_ BAI4GUARANTEES 9.01CATED 1C
FOR WHOM E SURVEY 8 PREPARED AAJID RUN ON HIS BEHALF SUiiO CO•Dept Pro liea Bion
THE TITLE COMPANY,GOJF3NMENTA. AGENCY APO LENDING EWirOnnitl 'C p
INSTITUTION LISTED HEREON,AND 10 TIE ASSIGNEES OF THE SCALL:�"as 80 DATE:a"l1NE 24 t9$f1
LENDING INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE
TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. SUFFOLK COUNTY TAX MAP SURVEYED BY * NEW y
EASEMENTS AND/OR SUBSURFACE STRUCTURES RECORDED OR `?�:71f11C77f•]lS.7.l'•:•:!T•]1■ 0 O
UNRECORIDlED ARC NOT GUARANTEED UNLESS PHYSICALLY DIST. SECT. BLK. LOT LOTHAR K.REISSIG ,S7
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EVIDENT ON THE PREMISES AT THE TIME OF SURVEY. 4 DIANE LANE r 41 f,
PROPOSED HOUSE LOCATION —_ ``
THE OFFSETS OR DIMENSIONS SHOWN HMCo,ROA THE EAST MORICHES, �a
PROPERTY UNES TO THE STHu:IURES.ARE FOR SPECIFIC S 1�„ �, +,�_�_ ! {��,
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PURPOSE AND USE, THEREFORE THEY ARE NOT INTENDED LIC. 49250 4 . t IL—
W MONUMENT THE PROPERTY LINES OR TO GUIDE THE IrIrETT"? '!1?' ifTT7'"E'."' SrCLi +tiabcok \l s
ERECTION OF FENCES, ADOITIE»MAL sTRUCTIKS OR ANY imommummumememm�r PHONE(516)878.. ,of Nu. 497- ,'-
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