HomeMy WebLinkAboutJerome I;-`4:gf
� `'� Town Hall, 53095 Main Road
P.O. Box 1179
_` / i'�• Southold, New York 11971
JUDITH T.TERRY -�:-�- �''�/' FAX(516)765-1823
l'�"����� TELEPHONE(516)765-1801
TOWN CLERK
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 601 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JEROME, JOHN H.
Address 1 : RD #3, MAPLE AVENUE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 4/9/90.
Name Of Owner JEROME, JOHN H.
Mailing Address 1 RD #3, MAPLE AVENUE
City St Zip SOUTHOLD NY 11971
Property Address 1 DONNA DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 15 lot 27.000
Cross Street NEW SUFFOLK AVENUE
Building Permit Number Cross Reference:
Issue Date: 5/03/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
_ _ 17
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a � ` ► , Town Hall, 53095 Main Road
BLDG. DEPT. :to �: ,, 7{ T �.
TOWN OF SOUTHOLD I .V) 1-" -1`�®�-�1 P.O. Box 1179
_ '� ihi �y\`����� Southold, New York 11971
JUDITH T.TERRY 1��w„li,Ii� TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
-
To: Southold Town Code Enforcement Officer
From: Linda Cooper, Southold Town Clerk's Office
Dated: April 1.8, 1990
' Transmitted herewith is a copy of application No. 616 for a Cesspool/
Septic Tank Construction Permit submitted by:
John H. Jerome
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:
APPROVE
DISAPPROVE •
Comments: riAC' C t,%%_ N-
• li- .). \ a zr, /iv, L1c\itt.
\C-3/-0-,4.. Ct...2.-2•43‘.4.--ri___
•
Signature
•
Dated
OFFICE OF THE TOWN CLERK ' ' ,c0FD(,(
Town of Southold z 0�-47: (-V
Judith T. Terry, Town "Clerk° Application Nol.91,
Town Hall, 53095 Main Road ; s ^• Construction
P. O. Box 1179 u,. =;
Southold, New York 11971
® Alteration
�"
Telephone "44l [ - tc Residential
(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 y /7 f c�0
APPLICANT NAME: JO) p-/ Niec"0 e-
APPLICANT ADDRESS: R D 0 "iv le_ 4 Oe_.
,So,.iA„ Aix. //q 7 /
SEPTIC /CESSPOOL C/
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/ ,e,6/e ,e-?,v/4. d- 12' o F aS5fa o,� -
N Ew FAL y Pct./ c L L, A, c-
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: C-70 if✓U c rvt—L
OWNER MAILING ADDRESS: 9D-3 cfJe /� fir'
_S 41J /d /Jy. /197/
OWNER PROPERTY ADDRESS: Donnok DGve Moi7"1"I 4c1(
TELEPHONE NUMBER OF CONTACT PERSON: 763'1-
TAX
63 TAX MAP NO. : Section /414-, 60 Block f_5--,0o Lot 2.7
CROSS STREET: 'J el,)
BUILDING PERMIT NUMBER CROSS REFERENCE:
1, /„/1 Rgvirvt--e_—
Signature af Applicant
RECEIVED BY:
own CI rk's Cy fi� �=p
,DATE: V// (� °
SPR G 19
Tho locations of waits and cesspools shown hereon aro fn
FOLK COUNTY DEPARTMENT OF HEALTH SERVICES obsarratlons and or from data obtained how others.
.4.
FOR APPROVAL OF CONSTRUCTION ONLY
DATE L(_y— K a REF.NO. C 0'17 ,
APPROVED " - SkY\67\ NEW SUFFOLK AVL
LOT 126 /
LOT / 41 /
!DWELLING)
(DWELLING) 111
WGL1. pytL /00 '!
FN0
MOM 0.2T 041E S or 19' 20" E 182.00'
0•2W A_E0.3W
FE>► I ' 20.0 I0C'
OJW \b1
OJ.v - 1
s
O
gr.
' 3/.I7 `
O
ST
yr
W .1, N 0
LOT/40 / m • o �O
LOT / 27 / •N '3�`, •0
n
NI
.07
(DWELLING) W `r s.' 0
s o
( c F �g-Ae yaRDl o : v.
w6LL OWE OZ t00. l ° o pro
• ya. T d r,vt 4
Ilt 4- N
S ._ _--
O 1
2 So
FEO.sW N6;'
f°-V.4 A-' RAX Fi f )\-
— — FNA /92y 182 1"FaTh114.0O' 1 FENC PIPE `
• FE F 1.gS
0.9'S 1.0'S N 87' 19' 20' W
LOT / 39 / I LOT / 28 /
` (DWELLING) • (DWELLING)
C•
c p keAt yAe,1
\
N e 41. O I/' mo' //
Prepared in accordance with the minimum
standards for title surveys as established 0by the L.I.A.L.S. and approved and adopted
for such use by The New York State Land
Title Association.
-
AREA= 20,020 SQ. FT.
•
ld The water supply and sewage o7sposal .
systems fog this residence wN conform
to the standards of The Suffolk County
Department of Health Services.
. ) ?IC
' 162-- IVED
UE
APR 6 1990
4 S.C. DEPT. OF
it
HEALTI-I SERVICES
o SURVEY OF
..., _.� � •
LOT 27-
,• al I.
J
MAP OF
STK 3 20 3 ° "DEEP HOLE 'CREEK ES TA TE '®
20.4;
FILED JANUARY 28, 1965 FILE NO. 4256
lb
W AT MA T TI T UCK
_ ____TOWN OF SOUTHOLD
�: ® SUFFOLK COUNTY, N. Y.
tzi 0 ® 1000 - 115 - 15 - 20
LILCOScale 1" = 30'
#$ March 9, 1990_ ..
e+ 4 ;
Z aka
nta _
3
u
t 4.....t„..„.4;i:i
i 1
FWD '-(O l AI Ov
r1 MON c4 CERTIFIED TO:
20.3 20.0FIRST AMERICAN TITLE INSURANCE
. COMPANY OF NEW YORK
JOHN JEROME
JANET M. DUDEK
LAPo'D\;
v 4 Y J, `.O v 4Cw �i
3 , ° 1, J ' ib, N. :a L/C. NO. 49668
aJ PEC NIC RVEY R P.C.
-7(.616 `, v50,20 -k-2:.:`:'Gg /
MAIN -GAtl. `' \d--
Aa?,c s, 1 9n SOUTHOLD; '. 11971
qn — 153