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HomeMy WebLinkAboutRoloff vb, il ,,foo\ois/kV FOL,�co -\ JUDITH T.TERRY ��_� y` Town Hall, 53095 Main Road TOWN CLERK % w _ ; P.O. Box 1179 h't $ Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(516)765-1823 � MARRIAGE OFFICER 40 0�•�i� Telephone(516) 765-18004� � RECORDS MANAGEMENT OFFICER 1 J �` 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. 1419 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : JURGEN P. ROLOFF Address 1 : 94 PANAMOKA TRAIL City St Zip RIDGE NY 11961 Descripton of Proposed Construction or Alteration SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. SCHD REF. #R10-95-0083 Name Of Owner ROLOFF, JURGEN P. Mailing Address 1 94 PANAMOKA TRAIL City St Zip RIDGE NY 11961 Property Address 1 1185 WESTPHALIA AVENUE City St Zip MATTITUCK NY 11952 Tax Map No. section 141 .00 block 2 lot 21 .003 Cross Street COUNTY ROUTE 48 Building Permit Number Cross Reference: Issue Date: 11/21/95 Judith T. Terry Southold Town Clerk (TOWN SEAL) • 1 - A* � • �, 5 `.,� JUDITH T.TERRY ' , Town Hall,53095 Main Road TOWN CLERK ;, ; ' P.O.Box 1179 = i. t4" Southold,New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER �� 1 ' Fax(516)765-1823 RECORDS MANAGEMENT OFFICER �� �y� Telephone(516)765-1800 FREEDOM OF INFORMATION OFFICER ,••i' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD I ,n),', 1' NOV 1 5 1995 TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's OfficeDATED: November 15, 1995 Transmitted herewith is a copy of application No. 1473 for a Cesspool/ Septic Tank Construction Permit submitted by: Jurgen P. Roloff 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: .. Cc'� I v- 9's - / Asir Signat 'e /d//6/4:(---- Dated OFFIC' OF THE TOWN CLERK ,.,'"" own of SoutholdJudith T. Terry, Town Clerk ,' liy�. Application No. /q-73 Town Hall, 53095 Main Road �� Construction L P. O. Box 1179 Alteration Southold, New York 11971 U' Telephone ®,�� ®��' $10.00 - Residential (516) 765-1801 = 1 ,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 ////Y/95- APPLICANT NAME: Po o , &A/' APPLICANT ADDRESS: 9 / /3/VA Mo/ /1 7 A/ A/z) E , v y. // 9 6/ SEPTIC )C CESSPOOL )< DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION //w Sj A.) G0/7-17/ t66-7/477-/ LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: o/GL/26;E-/V /? ROLOGF OWNER MAILING ADDRESS: 9/ /99.9.01-Itio,,,A T7. R./.6E--, Al/V. /1 / OWNER PROPERTY ADDRESS: //3'.� Z4)55 7-/i-714- L.//1 Au- /Li/977// 7/z.e/c- /L/ TELEPHONE NUMBER OF CONTACT PERSON -376 - 21c"? 9- 370/Slv- 69? TAX MAP NO. : Section Block c . Lot 0:2/, 3 CROSS STREET: 0, / • BUILDING PERMIT NUMBER CROSS REFERENCE: Sig ature of" p: 'd: t RECEIVED BY: Town Clerk's Office DATE: ''ATAOW-OR AAOl7DV TO THIS-SURVEY ISA VIACATIOW m/� � -:':�` AREA - 55 663 sq. ft. lam familiar with -the STANDARDS FOR APPROVAL' - J 7209 OF 771E-NEW YORK STATE EDU'CA T710N LAM', NI)•rrY - .l.:.--c:, �`2 c ' AND. CONSTRUCTION OF SUBSURFACE SEWAGE '" . .., ' . PE'sSf�CTlnc r7zo9-s 90VV N Z.ALL CERTFICA T7G1NS - _Y = VAL T,UFA4 INS MAP Ano COPIES THEREOF OR+C r F �s' > DISPOSAL -SYSTEMS FOR`SINGLE,FAMILY_RESIDENCES• ,; - tA ,,5 and will abide by the .conditions. set forth therein and'on.-the 4COPES SEAR HE 7Y°l�SS«ED SEAL OF-TSE SURVEYOR r� permit Jo construct. 4 TYKE APPEARS/fREOAL S. ` ji! - - - ' Y TO COMPLY WITH SAD LAM' THE TERM 'ALTERED BY' `pa ��'0ODO` ¢ �� ell a SED BY ANY AND ALL 'SURVEYORS UTILIZING A COPY -4 . �. ;, , 4`/ }ti° {o The locations of wells and cesspools - - R SURVEYOR'S INP. TERNS suai AS VISPE'CTEb'AND F 0-0ATF'ARE NOT N COAFLIANE M?TH THE LAM: \ AO ' k �p ;�D shown hereon are from field observations 70NS ARE REFERENCED TO AN ASSUMED DATUM. �,e�ie P( �q6 -i; •op. `�� and or from data obtained from others. ^ G� �h °�. • TEST BORING _ : - F=j L �' BROWN LOAMY O O k O - �. ,, , • \1 4 nQ''1 PALE BROWN:- ' _...: ^ T CERTIFIED TO' FINE Tn {� "' - JERGEN ROL OFF COARSE SAND 4 o r:S' <� , 8.I• WATER IN PALE BROWN FIVE . �. ••�• �" TSAARSE . _ - 0 -tri / ; 1. 4 �� oto `S' c.���oocg-7e, Q f FRQS '�\ �O °�` D� �? '>o . , i. �"�� din \O SURVEY OF • �� -� L� L .O T 1 . � ° - ..,5r8 - FROM MAP OF ,'. �`'.44 88. a MINOR SUBDIVISION FOR g °�`' �s. v�° - � D� 1 RORER T D HA MIL TON -- � �@- ` , , FILED APR22,- 1993NO 9343 .':'!,i;_. .'__ 0 FILE �'�� Q,� q r 4� - - A T ;.MA T TI TUCK :5 ' r;: ��; Qo�Q ' SQr _ o� ;� TOWN OF SOUT7HOLD • :-;;: �,�° ��: " - tion`• �(" SUFFOLK-COUNTY,.N Y - - . - . `- 21.2 /3$' ti , - ;,fir z -; 41$:. ‘10440 • /� r ( �= ' ,,a >-=-�. - o , Scale 1 4� Y'�' Y so „_ =� =` �� Feb. 7,1995 . `o", �, 60y,,� o, �,� s _ . • V Aug. 18, 1995(ADDl77DNS). ::`'. .40 , " - '� QT .:, 99• • st •O.x COUNTY DEPARTMENT OF HEALTH SERVICESr,e3,.,,,„,,,,,,wE C .'' © r92 `� FOR APPROVAL OF CONSTRUCTION ONLY ` 3., N.Y.S. LIC. NO. 496/8 '�� . ��� ik _ - - D P 14 1 - RIO-95-0083 SEP 1995 SURVEYORS, P.C. - 3. ' ' �' �' - 5020 �,"; _ y; 909 •t'~ i S.C. DEPT. OF/ �t JV v 11 97,