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HomeMy WebLinkAboutForssell, Jeremy vor OOFF04 %• h y� Town Hall, 53095 Main Road EIsIZABETH A.NEVILLE y TOWN CLERK -� P.O. Box 1179 2 % Southold, New York 11971 REGISTRAR OF VITAL STATISTICS %%%°44 �t Fax (516) 765-1823 MARRIAGE OFFICER � y ���� Telephone(516) 765-1800 RECORDS MANAGEMENT OFFICER : �Ql so'�� 6 FREEDOM OF INFORMATION OFFICER ���� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1930 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : JEREMY FORSSELL Address 1 : 82 RUGBY DRIVE WEST City St Zip SHIRLEY NY 11967 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 # R10-98-0113 Name Of Owner JEREMY FORSSELL Mailing Address 1 82 RUGBY DRIVE WEST City St Zip SHRILEY NY 11967 Property Address 1 SEVENTH STREET City St Zip LAUREL NY 11939 Tax Map No. section 126.00 block 1 lot 22.000 Cross Street BRAY AVENUE Building Permit Number Cross Reference: Issue Date: 9/24/98 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) /,,,„..................... / �j 36) II g�FFO1� / l lg \0 C - ELTcZABETH A.NEVII.LE ����`�`� �Gy��` Town Hall, 53095 Main Road • TOWN CLERK ; p 1 P.O. Box 1179 H Southold, New York 11971 REGISTRAR OF VITAL STATISTICS �'�� ^ Fax (516) 765-1823 MARRIAGE OFFICER : y ����� Telephone(516) 765-1800 RECORDS MANAGEMENT OFFICER �Ql *a FREEDOM OF INFORMATION OFFICER W OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: September 21, 1998 Transmitted herewith is a copy of application No. 2010 for a Cesspool/ Septic Tank Construction Permit submitted by: Jeremy Forssell . 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 recommendations:r APPROVE DISAPPROVE Comments: S• natur" 1254. 41l-z-(� d) Dated OFFICE OF THE TOWN CLERK c0FULk ,' Town of Southold 0�0 D Judith T. Terry, Town Clerk j _"' Application No. abl() Town Hall, 53095 Main Road c Construction ✓ 1YO i P. O. Box 1179 to �° _ Southold, New York 11971 Alteration Telephone *0l [ NO Residential t.// (516) 765-1801 Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ DATE Seel- I b , 9 APPLICANT NAME: (Z6 L (-Z SS El APPLICANT ADDRESS: e 2_ c c �6 ,( ,--- A-- , \,,,N SEPTIC CESSPOOL K DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION CA-Pe LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR �ALLTERATION: OWNER OF PROPERTY: . � pl � C1 .t t 1 OWNER MAILING ADDRESS: B T.- gsgk/ bc,� Shty\c OWNER PROPERTY ADDRESS: TELEPHONE NUMBER OF CONTACT PERSON: C'-( �� 22. ( -( j 7 8 TAX MAP NO. : Section 1 2Gnw Block b I , 0 O Lot b-2.:?__ .C.. O 0 '-Y2- tt CROSS STREET: PJ 06 BUILDING PERMIT NUMBER CROSS REFERENCE:_. / 1 Signa re Applicant RECEIVED BY: ` /. ow Clerk's Office DATE: q - ---q ' • SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES • • w S pLK COUNTY DEPARTMENT OF HEALTH SERVICES Vet) 1 APPROVAL OF a UCI'IOPI FOR A PZRMn'FOR EMU!FAMILY RESIDI NCI ONLY ��` n'►,'-�-. DATE 'Z I -9 g :4- ..- . . 0 y $ - 0 P 3 ....__ \ Ar APPRovfiD 1 ,r G wT5 rot lylA)a ium OF 4 , OOMS T'1-1 . S T' u- wt., EXPIRES MIME'YEARS FROM DATE OF APPROVAL. 4stai IA ro9°13'10" 9 . V `Roeoti.oS iDAD _ 4 d i R> 25D.0C> NOTES -� TEST HOLE Q 7 tigg1) SAME AS DIST: 100 O ,SEC: IZ(o Ela(: I TOP OF T.M.: el 108.0 U _•, LOT: Z.Z. ON SUFFOLK COUNTY TAX MAPS. 1 V' S' 0 1 U d r ® 0 O 2) THE EXISTENCE OF ANY RIGHT OF WAYS AND OR EASEMENT mor . , Q Q ,oo 0 n OF RECORD.IF ANY NOT SHOWN,NOT GUARANTEED. Law g N r c' C g 0 — $ So, i J 3) EL EVAT ONS ARE SHOWN IN ASSJMED DATUM. se�o Z, I a o Q Z� ^ "�"� O� 4) THE LOCATION OF WATER SUPPLY�,,�` �AN�D SANITARY SYSTEM, 1 40' SHOWN AS PER DDC�ltJl3 R,9 ,NOT GUARANTEED. e -o" 0 r .7_-.) s) ( ) = PROPOSED GRADES. c"kms -ca �Q.OPO ISI • p $IWJD SEo () d s) Z� _ K-40 4 O 0 owG`�..-..v ^ ' 1.1 v o d J' S<�RffI7 ,Ll 7) LOT AREA = 14,746 S.F. i7' J ) �l .. it �7J 5) SANITARY SYSTEM FOR UP TO(4)FOUR BEDROOM HOUSE: J r' °• •-�—• SEPTIC TANK=1000 GALLONS. li �' - I Q *UNAUTHORIZED ALTERATIONS OR ADDITIONS TO THIS SURVEY IS A VIOLATION OF SECTION 7205 d _ • OF THE NEW YORK STATE EDUCATION LAW. O •COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL SHALL NOT BE �Q I CONSIDERED TO BE A VALID TRUE COPY. U -V •CERTIFICATIONS INDICATED HEREON SMALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS ( Z) PREPARED,AND ON THEIR BEHALF TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AND LENDING al O iINSTITUTION LISTED HEREON •CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL 0 o INSTITUTIONS OR SUBSEQUENT OWNERS. ' 1,41) I ,n *THE OFFSETS FROM PROPERTY LINES SHOWN HEREON ARE NOT INTENDED TO GUIDE IN THE 2- U' OExST• ION ERECTION OF FENCES,RETAINING WALLS,POOLS,BLDG.ADDmTmONS,AND OR OTHER CONSTRUCT . © .COPYRIGHT BY ROBERT B.HOLZMAN L.S., ORIGINALAS PER DATE SHOWN ON SURVEY. 7 6e 1�F NEW SURVEY o.�'Se. ,.:�..t 11.111.6410M. o ,: ,cQ. 1 B.HOi 14,Q (.t?[5.74 tZLuGt-•} 011 MAP Or, S locio 13 10"yV J 0.,•,-- 105.-15 e.r: '`�' 5O DIV 15 I ON1 MAP OF � &1s7 ,� u �N�{i S AREA 1* Cr t - y , �� W� :F . ll..l,- , OTS ,: '„,„:� OD <J 1 0 it., CGTIpt.1 me. DST: a a.4 ei 0 . D,0 �,�F�fukk, `,ALL 15,1924 Fi.Lo cit—AP�}Q_1 6i• - `�(�� 3 O �<'y Qa E'LIST Ex I S T P,�S O .1, i. L��JUI�.;t. ,'TUWi4 Or �J' OC7'�OLD •J M:1-K C•000 j`1! (JOIN "( '998 tZes Res • sr �v‘9$.0(54911 PJ ' C BY ROBERT B. HOLZMAN L.S. 1998 a- - �.c. CAMDgv �� , UCENSED LAND SURVEYOR , N.Y.S. LIC. #49176 ilf 1205 WALNUT AVENUE BOHEMIA , N.Y. 11716 11J ��9� PHONE # : 516 589 0261 FAX # : 516 589 4930 FROG-T , DATE : .I.,.� z. •g�a I SCALE : ‘.. . .. .:=.• :m FILE 1000-126-I-Z2- 1