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HomeMy WebLinkAboutKupecki ,�o,�gUfFO(�-BOG ELIZABETH A.NEVILLE t j ?�: Town Hall, 53095 Main Road TOWN CLERK H P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER � y �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �_�®� ., , ' Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER 00' OFFICE OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 2488 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : ANDREAS J. KUPECKI Address 1 : 1755 STANLEY ROAD City St Zip MATTITUCK NY 11952 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 # R10-00-0183 Name Of Owner KUPECKI, ANDREAS J. Mailing Address 1 1755 STANLEY ROAD City St Zip MATTITUCK NY 11952 Property Address 1 1755 STANLEY ROAD City St Zip MATTITUCK NY 11952 Tax Map No. section 106.00 block 7 lot 37.000 Cross Street SUNNY LANE Building Permit Number Cross Reference: Issue Date: 12/29/00 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) Woo. --- ),u( '6`K • ELIZABETH A.NEVILLE ���,= Gyrr-i•: Town Hall, 53095 Main Road TOWN CLERK ; y 2P.O. Box 1179 REGISTRAR OF VITAL STATISTICS / Southold, New York 11971 MARRIAGE OFFICER �. y 4,_s. Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER = �®1 �°�®�ii� Telephone (631) 765-1800 4.FREEDOM OF INFORMATION OFFICER _ ��� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: December 19, 2000 Transmitted herewith is a copy of application No. 2576 for a Cesspool/Septic Tank CONSTRUCTION/ALTERATION Permit submitted by: Andreas J. Kupecki 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 Z' DISAPPROVE Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water Bodies. EXCAVATION INSPECTION REQUIRED. gnature I2 2 6 (a 0 Dated '"i)FFICEOFTHE TOWN CLERK1� ``��OLL/n' TOWN OF SOUTHOLD .10� ire; 5 Application No. 27 FT.I7ABETH A.NEVA.IF,TOWN CLERK ,� o . P.O.BOX 1179 1><,. Construction SOUTHOLD,NEW YORK 11971 v T Alteration Telephone ��O 1 $10.00 -Residential bc. (631) 765-1800 �Ol114 $25.00 -Non-Residential .,.,,,,, TOWN OF SOUTHOLD I SOUTHOLD WASTEWATER DISPOSAL DISTRICT • APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee .$ DATE eG / 9/ ®® % APPLICANT NAME: e/4h d re-&S K-'1?-64-" APPLICANT ADDRESS: /7.55 .5.71-e=0-1 /ey Ec fll �� k 'v Y /1q SEPTIC__�/ CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION Me w Co s74 L.,C.7i"o,7 LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: ,4/�dreciS , /<v e '_/) OWNER MAILING ADDRESS: /755 5 6 n i-e-y Ad' OV1a 74-/-it'vt �_ ,vY Il Sa OWNER PROPERTY ADDRESS: S-/�r� /-&y Rc, /f4+4-174t k TELEPHONE NUMBER OF CONTACT PERSON: 63/ c -9 '- 8905 TAX MAP NO. : Section /1) 6 Block D 7 Lot 3 7 CROSS STREET: St"" y Lah -e— BUILDING PERMIT NUMBER CROSS REFEREN KJ2 Signature of Applicant RECEIVED BY: • -rk's Office DATE: 0 O - . I om."famillar with the STANDARDS FOR APPROVAL ' AND CONSTRUCTION OF SUBSURFACE SEWAGE ANY ALTERATION_OR ADDITION TO THIS SURVEY JS-A i�/IIQ.AT1@N �-, DISPOSAL SYSTEM.S-FCR SINGLE:FAMIL Y RESIDENCES OF SECTION 1209 OF THE NEW YORK STATE- T'(pN--L'AW.". EXCEPT'AS,PER SECTION 7209 - SUBDIVISION'Z Aft-•! TI ATlONs _: and will abide by the conditions set forth therein and on the HEREON ARE VALID FOR THIS MAP-AND COPIES TH .©NL r IF • permit to construct. SAID MAP OR COPIES BEAR THE IMPRESSED:SEAL-OF THE:SURVEYOR WHOSE SIGNATURE APPEARS HEREON. • ` L0T 0 - ADDITIONALLY TO COMPLY WITH SAID LAW THE TERM 'AL BY' T MUST BE USED BY ANY AND ALL SURVEYOR$-,U7lLIf&=�1' FY LOT ��'T• OF ANOTHER-SLRVEYOR`S-MAP. TERMS SUCH AS:'INSREC7 AAN$ `r ' CAPTAIN K1�9D ESTA-TES 'BROUGHT-TO-DATE' ARE NOT IN CO 11?Tlf TNE••LAW._ DULLING I . , \_____,____ D LOT 9 - I 77, The -locations of wells (Ind. " :cesspools 121. cif shown hereon are NO,J :eb-seiavdtlolrs ae N. 81'26'20' E. i a� ELMO 04F and or from data obtained Iron- others. 'x..64.9 i .-11 • ELEVATIONS ARE REFERENCED - Z f - - - TO AN ASSUMED DATUM: OD O • CI t) _4_- �� } 6 ;, �' LC? O s «„n r� 3. . 70 ;tea r _ . mer a. —cn . 1C7 \"... G�C:f ;Q fir^ !=)•LOT 0 LOT ® - . „ ,. • vAcio P�b,1O wat .. L: : , ,.,,,,,._-,,::,:-.::::_:....:: _.:, i CERTIFIED TO: ANDREW KUPECKI Lor 0 • - I FIDE ITY NA TONAL -Ti-TLE- 40 IN RANCE COMPANY : c, 0WD,, a,.}e r) 40' TITLE NO. FN-T992132 ' - r ( Pibr1� Pr©P ,.. 40' hs '. I . -' �4i?EA fak Z S• 0giern4, ` m' �, ee a RI 12p,00 . ix 0 ti To( ROA T AWA7 ' STR F. 60.4 ( Pt19L(C • - 1 LOT 18 ” 19 _ L0 ,. \ MsE We 0 ' SURVEY OF , LOT LOT 4 • ,,,,,,,„T "MAP OF SUNSET KNOLLS- SECTION TWO" FILED APRIL 9, 1970-FILE NO. 5448 . evesnewestAT MA TTOTUCK sy H P. ,, ., _FOR SANITARY ; TOWN OF SOUTHOLD .-_-_ -.-• — SUFFOLK COUNTY N Y. y `'�.c I 1000 - 106 - 07 - 3f SUFFOLK COUNTY L��PkR`"Pir-:�': c.' ! - - SCALE r' so' . MAY 24, 1999 ' i D1v --, 12b..`„ D ''•�\ F NE '\ ('-' LiLig,k20 ov A?PI;OVt D..._.......,......_;1 _,__„��_; s _ �� .Or_ - - 1' g ` , S LIC. IVO. 496/8 Fon F ? t:P IBJ`3 :o y'' _FOUR s�� k4�ito 's'. i'•, c n. v.a _ �,� ,` ;;;r: `�a„�#� 'MC ya'k, Ili YO .C. EXPIRES i�F2�� 76-= ---il'0 _�--- - r. :QX 909. �o - - - • f ET 08/25/99(cerl/kallon), SO �r f<97I. . _ 99 = 193 _ .