HomeMy WebLinkAboutFox, Dana d"� L,j
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ELIZABETH A. NEVILLE ts� 'y ;
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OFFOL j AcG 2
ELIZABETH A. NEVILLE ,�� � % Town Hall, 53095 Main Road
TOWN CLERK ; y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS PP7
Southold, New York 11971
MARRIAGE OFFICER � ,fiL � ���, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =_ 7Q1 # .0.. � Fax
(631) 765-1800
F; i• a . .•r PSA I FFICER - rrrsoutholdtown.northfork.net
P I8 2002 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: — Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 17, 2002
Transmitted herewith is a copy of application No. - 2906 for a Cesspool/Septic Tank Construction
Permit submitted by:
Dana Fox
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: /��
Signature
a ,/A-,7/0-2--
Dated
" OFFICE OF THE TOWN CLERK $11/
TOWN OF SOUTHOLD Application No. 90(0
ELIZABETH A.NEVJJ.I.F,TOWN CLERK � �rO OV
P.O.BOX 1179 : Construction
SOUTHOLD,NEW YORK 11971 Z
Alteration
Telephone ,� tsbs $10.00 - Residential 17
(516) 765-1801
- � '' $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/so
APPLICANT NAME: :- /,/7yjZ
APPLICANT ADDRESS: s �� ,4h
/6977/1`11C& Aly //rf '
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
isebtrArd
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST UCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: 3o S 7
OWNER PROPERTY ADDRESS: ,e_e_44
TELEPHONE NUMBER OF CONTACT PERSON:
,111-1
TAX MAP NO. : Section Block —h7 Lot zfitS Z
CROSS STREET: 6,,) ,t-4( it
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of plicant
RECEIVED BY: # a
Town Clerk's Office
DATE: 11102._
F
TEST HOLE DATA
PERFORMED BY McDONALD GEOSCIENCE
15 AUGUST 2000
EXISTING GRADE
SURVEY OF j
BROWN LOAMY SAND SM DESCRIBED PR OPER T Y
SITUATE
PALE BROWN FINE SAND SP MA TTI TUCK, TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
RESIDENCE
RESIDENCE U/C
• 17' VACANT
N SURVEYED FOR DANA FOX
FOR S.G.D.P.S. USE ONLY v;
Oy
o U CESSPOOL
0 z N/F SCHELIN , CESSPOOL
, G' C SURVEYED 17 AUGUST 2001
0 30 R/, Np f CESSPOOL N F FOX SCALE 1"=30'
.TOE BLE RO /
La co a ° • ' ;0" •' ,I__48. 4 u-,— SURFq ��SQo RESIDENCE —
150 +TO CESSPOOL I, 010 C 0 AREA- 18,731.256 SF
U Q �_ r� �„IP E OR
WELL
m l� ,� to Qa �i ` IP / / o_ / 82 0 150'+ TO 0.430 ACRES
WI Z i G 4 179' TO WELL N // '• /
z O J 'O ce IL �' A/ PROPOSED m ,\ 7�-1 j
Y . v
B U 0 m O O Cd ,0RIVE0✓A / u PROPOSED - -i
W 'O m W v 4 s S — 'PROPOSED �7 ZONED R40
v \ h unL 0 EP TIC ' O FUTURE EXP. POOL
QCESSPOOL
IL. ca Z ` 0 W ti POL 35' O � I TANK /�
r--------1_
O C O O 11 C C // 1/ 0> /- GUARANTEES INDICATED HERE ON SHALL RUN
W U w • J' W Q �a / �� R N/F HAWKINS
ONLY TO THE PERSON FOR WHOM THE SURVEY
4- cc W PROP1 ED HOUSE �c�c.,C \ / TEST ' j IS PREPARED, AND ON HIS BEHALF TO THE
c� 0 -•LE _7\..-_,_- RESIDENCE TITLE COMPANY, GOVERNMENTAL AGENCY,
aa Ld 4. m o 35' �\�R OM�(O X O LENDING INSTITUTION, IF LISTED HEREON, AND
} ij Q O I OV , TO THE ASSIGNEES OF THE LENDING INSTITUTION.
W O COQ -� •0 _� / GUARANTEES ARE NOT TRANSFERABLE TO
CI Q W = 1 �� CESSP00 ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS.
G
O Z 0 = W Cl-, N C // \\ UNAUTHORIZED ALTERATION OR ADDITION TO THIS
O i' ff� N i 1,,) / 0 O \ SURVEY IS A VIOLATION OF SECTION 7209 OF
V (j, N .-- • CN'' \ THE NEW YORK STATE EDUCATION LAW.
A w w `P�. TO oESSP9SL °-„ ,c;.
\\
O▪ a .... } IX s WELL \ 1 jQ �\\A� 0' R \ COPIES OF THIS SURVE./'}IP ttQ BEARING
14, la Id a \ Vv - THE LAND SURVEYORS-E lgtOSS B SEAL SHALL
W Q. I- O. d N / '0NOT BE CONSIDERED ID-B€ A VAPID TRUE
F V- COPY ;
U) O Q a' W /1'0'+ TO CESSP I OL 1 �� / '\�0 << tr)
I-LJtt
s oOL 39` 42' ,
c f
z To SEs P S 00” W /� j,;
LI 50 0 /
179.85'7\Qs
k o0
11.1 j
1�C1 N/F BAKTID Y ,
• / W RESIDENCE 1I � ; SURVEYED =$<X L
`' U I
J\ STANLEY J. ISAKSEN, JR.
r CESSPOD �/
/i P.D. BOX 294
TM 1000-114-07-5.2 RESIDENCE
NEW/ UFFOLK, NY 119 ..
631 , 73 583.5
GUARANTEED TO �1r.,„7"r' 0 ,/
DANA FOX CR 48 NORTH ROD IC NS I _AND SU,r'VEYOR
FIDELITY NATIONAL TITLE INS. CO. OF NY
NYS L, NO. 4923
01C1048