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HomeMy WebLinkAboutBacon „i 0004 ELIZABETH A.NEVILLE � � Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 • Southold, New York 11971 REGISTRAR OF VITAL STATISTICS . ® Fax (631) 765-6145 MARRIAGE OFFICER ,11 RECORDS MANAGEMENT OFFICER = tet. sZ . ,,, Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER '.� i'� OFFICE OF THE TOWN CLERK SOUTHOLD VANS71�RTR SAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 2573 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : SAMUEL & STEELEMAN Address 1 : 25235 MAIN ROAD City St Zip CUTCHOGUE NY 11935 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 #R10-01-0023 Name Of Owner BACON, PHILIP & SUSAN Mailing Address 1 18 ROXBURY ROAD City St Zip GARDEN CITY NY 11530 Property Address 1 3335 NASSAU POINT ROAD City St Zip CUTCHOGUE NY 11935 Tax Map No. section 111 .00 block 9 lot 2.000 Cross Street OLD MENHADEN ROAD Building Permit Number Cross Reference: Issue Date: 5/01/01 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) • „,,o� S11FF0�,�co ELIZABETH A. NEVILLE i � ` G�� Town Hall, 53095 Main Road TOWN CLERK ky P.O. Box 1179 vr� Southold, New York 11971 REGISTRAR OF VITAL STATISTICS t Fax (631) 765-6145 MARRIAGE OFFICER :®4i RECORDS MANAGEMENT OFFICER ? 01 **011' Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER - 0" OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: April 18, 2001 Transmitted herewith is a copy of application No. 2649 for a Cesspool/Septic Tank CONSTRUCTION/ALTERATION Permit submitted by: Samuel& Steelman for Philip & Susan Bacon 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: Maintain required setbacks from adjacent wells,buildings, property lines and water Bodies. EXCAVATION INSPECTION REQUIRED. . Signator Sit /d ( Dated • etFF1i t OF THE TOWN CLERK i �� 0, -7' Town of Southold ��- Application No cUr Y' Judith T. Terry, Town Clerk Town Hall, 53095 Maih Road ;z $10.00 - Residential c� P. O. Box 1179 to A ;' $25.00 - Non-Residehtial Southold, New York 11971 Q0 Telephone ,t * / (516) 765-1801 TOWN OP SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for" °-05N45-reCe Cr7et-0167-4442-,77 /1-/ ERMIT SEPTIC TANK or CESSPOOL • Operation Permit No. - Fee $ • DATE �� /-diae OWNER NAME; f�/,Z-ec), &G($4 ) 5 ,6 e9 OWNER MAILING ADDRESS: ,r ^ ; � .0t40 -� ,D.c�•' Ci7y,. te(-) V. /753 OWNER PROPERTY ADDRESS: .� 33 5 1 5 )049a.-77 /9j* - OWNER TELEPHONE NUMBER: Com'( 73 ' TAX MAP NO. : Section //( Block < Lot CROSS STREET: ®G,D ir-/&"-A.)/09,o,,05t) Xe?1) . TYPE OF SYSTEM: Septic Tahk v New Existing Cesspool New Existing Residehtial Non-Residential LOCATION MAP: Must be attached hereto before permit may be issued. (Locate building and system; give north arrow and feet of distance, approximately, to building and closest road.) s / Signature of i scant • RECEIVED BY: Town Clerk's Office DATE: Water lines n r #.be inspected by the Suffolk County Dept. of Health Services . - - - - --.- .. _ Cati 852-2100, 24 hours 1n advance, ExlS?IIJc, -�)NDGIZCaRot�N(� NZkJ Li1-4PER.c,1Zo1.114p : to schedule ins eetfon($). �I•JA?� R sUr�P�Y LItiIE FRoM ! are. �- (5U P PL.,y 1.INs M��N A R cam.P To FOSA I?E' i�M�C E TO a AXI STI�ICy nlJTp4'��tE �or ►�oU � \ Iooe R, � . sNo-riS.R- et. 32 Vp-�es�Nc, �R-FA •4 FT I4 �-I P c 1-IAt� LINIL v@ Fg�•l c E \ N. i hj� is.a� o do i ' \ ,„,,, �9 I 4� INT / M N C N N N ,.......- - 11........... - .1- • , - \ . . _ _ ,, 5 --' u. / >- c1.4.-re,..'J I ` °J �` d • 1I `' ',••• j, 1f , 11 �) ' fti o M � "*' 1•10017 FG t. IG 1.74.4.Tera., M C 'lam I 7 g _;,, �? if L% r � _ : -. PIs�7 J p V ` �. a , '1, k. ',RPOOL. ) '< • _a4 Z0 0.c}r,- .`'. TE$T . ; ; ; . ,';\ :'' < x tit©LG pi TYg /_ 5T ' c ia. ce` IS, QQ 4 ax.155-1"i IV c, (,3T) cG.4 TII+015CK L ,_ _`` r� ,, , . ig / REr4itJII.ICy : /cyst- % ,' / id i i 7 Ext. 1..4 sp; 1,3_-2*....6.1.111t..1 I �,, ELP/ 1 ‘) 141 a N 4 4 . - IW FT NIGH �c,,aTE Z ti STc1JE RE.TH1KiiNK1 a u' L.1... , 1• til u 1 -I °Z J SGP"I t: L9y$T ; , , f o I I o 100°' y. &=1 Tl c TA*-4 K-C6'T � -- N I - F°�' 01#4 ,.4 'F'i r pea? g �. J f I_>:: c H i H'G, P...L- C L P) - J. 7 10 rl Il \�,,, i . \,\ .94.\-)--\: p'C' °1: -rte ,�It� ". _ S- --- cr7 G nit"" „ rj z locatibris of wells and cesspools h0wn” _:' s , Iv The al�d or 1;:r.,,,,,, hereon are from=fieldobservations. >': Y`data obtained from others. •: ;M' .`= '„iththestandardsfar approval HEAT-TN "! am familiar w .�u ' "`' . DEPARTMENT and construction of subsurface,sewage disposal •tis• DE ?AR sand vuifF ' t'= '`, ; systems for single family residence .-,•:.�' .� . STATEMENT y s set forth therin and on abide by the condition construct." ' the permit to �"""` ' , 1 % -,4 lots gfri SIGNED: �- : MAP ., ' ``72 ugenees R- _ ti .. 1 1-`, A,', 4'R<„ ~ 1 2 r,t ' ,." ... .,-"'9 r' i q-5'v 4._ + „$f • r9' - 0, • S1pl r, \...---\ { f,.. ;� - -- -.'• 3335 Nas.FAu r5Olflt ;; ...• t • t' •,„.:43 -;.r.40141 ` r_•_� u1',"4. 0 ue V.11'33 , ve a § ` � x ' r�� utCFf g t . ,, P as „ CZ Z 1- t• 1_•,'',,x_ t -, al's 6 m: '9:•:- - ' .: 4-• 10 —1 2 . c { 4:\'''A''" gal` gt•y (ry ��k ,1 re yiS4 , -�, .,"0 3z a+ " F :g" </0 M 26,r-1," - :1� �'' ; '!S' .0.,,,,- �' ,,,.., x :- " 0,4';',w'r+r .-r w F 4,4t w .-! • ua Z X If 4 i c.f _ 7.4: ? ' 1,'""\� ~ �' p; �' Z ., __ far , •t.,.- ,� - 'E 1(• "� 1 S,* k l' , w N = rA,. �; y1 yr h. �iig?„ ,4• .I • 4,,,',5-4', a. .y P,,,� ''..":2",.., e; i'",4 M at) , s - ..[2.,t41,,,,:;14,' i,,,,,._,„,..... •"t+ m1 xaa.1�.�' "S ... It ,t m+7 ai -i 4` k` ' „�u � �, h '! y 1 v - s < f • V M k h `(Sy } -:,„. F^-, i V . .,1::,.1. -� *' 1 ''.•ar '.. �D + y4:"..4„...- „fVgwSufkik AveAwe • 7, Y0.,,,,„,___________,,,,-, . * xi Ab ?r. , . ; ). a F L • �'�A,' '�xa,��,,,�e�„oa":<�s ;r�W } r. �,�„ � ,.-? 4 M� �'�' * t,„ � �r��jr � W � SS rk' xp k� f `_ P ® d! �e� SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICE3 /��`� PERMIT FOR APPROVAL OF CONSTRUCTION FOR A ..m., - a Ir l lf� 0Q, l ase Pro =Ct No: 2.4, Drawn By: LI..r. DATE -' - .°. r' C� o a a3 • APPROVED �� Checked 13y: T� FOR MAXIMUM OF'.0 .„.BEDROOMS - Date: EXPIRES"THREE YEARS-FROM-DATE OF APPROVAL l `5 c Scale:' Sheet Title: SITE , L PLAN` 4 e .'1 LiJ ;. Is 1 „c f:Y Lt SJJ — Sheet No: • a