HomeMy WebLinkAboutPavich, Joseph , 11 FFOt,j'
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ELIZABETH A.NEVILLE ts `�` Gym; Town Hall, 53095 Main Road
TOWN CLERK p 1 P.O. Box 1179
y 2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS rrt,�1 Fax(516) 765-6145
MARRIAGE OFFICER `
RECORDS MANAGEMENT OFFICER �� �IfO �O- Telephone (516) 765-1800
.I� Tele
FREEDOM OF INFORMATION OFFICER . '� l •��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2126 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ALBERT DULGERIAN
Address 1 : 19 OAKSIDE DRIVE
City St Zip SMITHTOWN NY 11787
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 *R10-99-014
Name Of Owner PAVICH, JOSEPH
Mailing Address 1 575 NORTH BRONSOM AVENUE
City St Zip LOS ANGELOS CA 90004
Property Address 1 1080 LANDS END ROAD
City St Zip ORIENT NY 11957
Tax Map No. section 15.00 block 9 lot 1 .028
Cross Street LATHTAM LANE
Building Permit Number Cross Reference:
Issue Date: 7/28/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE ��h`` y : Town Hall, 53095 Main Road
TOWN CLERK p3 ' . + O w E 4' P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � +y 1 ' Southold, New York 11971
MARRIAGE OFFICER O (_ *. # Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER `,y�Je w., 0 2 i99� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER _ ` ` i T oil
BLDG.DEPT.
TOWN OF SOUTHOLD
OFFICE OFTWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 21 , 1999
Transmitted herewith is a copy of application No. 2212 for a Cesspool/
Septic Tank Construction Permit submitted by:
Albert Dulgerian
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 mendations:
APPROVE
DISAPPROVE
Comments:
AC
ignature
A1ti, `49
Dated
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bFFICE OF THE TOWN CLERK �' �I FIkk
TOWN OF SOUTHOLD 0 �J CSG Application No.Z?i/ 2
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 et. _ Construction V
SOUTHOLD,NEW YORK 11971 p rn ; Alteration
ih
izr $10.00 - Residential
Telephone 0,��o �� S(
(516) 765-1801 _ 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 7 gel
APPLICANT NAME: /9 / gE,e T h
APPLICANT ADDRESS: it? Q f f(5 i f I)Jj
s m r%H 7-O lA) I' Ad /087
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION — -
NeLl) h o �
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: J--0 c 'ff /319 NI
{ /` , ��
OWNER MAILING ADDRESS: 5 75 NI R res cri !tel Ise
Los pnes.,4 CK3 9000L/
OWNER PROPERTY ADDRESS: /08-0 //9/k/ C---iii) ;? "
0/ /ems
TELEPHONE NUMBER OF CQNTACT PERSON:
TAX MAP NO. : Sect' BlociLot9tika
CROSS STREET: L. !Tjim A4 /_12A)E-
BUILDING PERMIT NUMBER CROSS REFERENCE:
,L$Signature o Applicant
RECEIVED BY: f_/(CD
To71e/ceifice
DATE: 7/ / (fice1-(
.
��r;�,.::CGUNTYDBP ��Zg
/ an familiar with the STANDARDS FOR APPROVAL
AND CONSTRUCTION OF SUBSURFACE SEWAGE F T^^'t AP^ROYAL OP'CONa7ZiU1 ON
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES �Ii�:;t, R�'.LY RL'S!DENCE 011ZY C
and WI abide by Me condMons set forth therein and on Me y
permit to construct. ':;'.-_ -/1:21 Pio,s•
APPROVED-_--.._._.�.. �`��j I .__
F D MA a TJ:,. of !ROOMS
EXDTRES THREE YEARS FROM DA78 OP APPROVAL
EXC VATgN INSPECTION REQU1RK,1
LOT ® FOR SANITARY oYSTEM•
-2 ( VACANT 1 SY
.�LDEPARTMENT
S. 88'57'40' E. 200.00' •
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LOT
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a.«h ![ ,,? (VACANT
4 N. 88'57'40- W. 200.00' 7g1
LOT 0
well /ovation (DWEILNG)
~ ,,nknooin CP.
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LAND'S END ROAD -
CERTIFIED TO' LA THAM LANE)
ALBERT DULGERIAN
LISA DULGERIAN '�p
COMMONWEALTH LAND TITLE 4;, SURVEY OF
INSURANCE COMPANY 0 i
'0'<, 0( LOT 28.
64,
S `5):a rFn �Iti41 Y% TBEi OF�N 5009
ELEVA AREREFERENCEv O%s�clz, YOB. A',TM,OR�IVT POyN�1/l�T�
TO AN ASSUMED DATUM. �O 40 F TOW OF SOUI &D
The locations of wells and cesspools 6,,legcO � 1b00 - '7SUFFOLK COUNTY N.Y.
211
shown hereon are from field observations E -
and or from data obtained from others. Pie • SCALE r a 40'G
MAYA WM
JUNE 16, 1999 ( update I
AREA = 40,000 sq ft. June 25, 1999(sca#.S in6)
ANY ALTERATION OR ADDITION TO THS SURVEY IS A VIOLATION 4's-s, 1.iter rQ.j►
SECT )7209 pF ME NEW YORK STATE EDUCATION LAW. .oP ?ee
T ASTER SECTION M9 SUBDIVISION 2. ALL CERTIFICATIONS �'
HEREON ARE VALID FOR Thi MAP AND COPIES TIEAEOF ONLY F * 11
SAC'MAP OR COPES BEAR APPEARS
ThE IMPRESSED SEAL OF THE SURVEYOR -,,�- �;�C N.Y.S. LIC. N0. 496/8
ROSE SWAM TIM PASREOM ,4 ;. ::ate U/:.:
ADWTp�Y TO COIPLY WITH SAID LAW THE TERN ALTEREADY' i%'. ;'' Ce' • - 50
ANY ( " YORS, P.C.
MR��ST AE UM BY AND ALL SURVEYORS un zays.A COPT ) a 5 5020
OFANDREA
TO-DI S MAP. TERMS T N u x ASirN rrnEE tr AND
MJF_, `§fig. -0X 909
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