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Home My WebLink AboutBoucher 4 ELIZABETH A. NEVILLE �0�� Town Hall, 53095 Main Road TOWN CLERK _ w:' ;r P.O. Box 1179 % Southold, New York 11971 REGISTRAR OF VITAL STATISTICS ; o; =` MARRIAGE OFFICER : 0, t�� Fax Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER =_ ®� �� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER .D" southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 2779 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : REALO BOUCHER Address 1 : 35 HARP LANE City St Zip SAYVILLE NY 11782 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 #R10-01-0165 Name Of Owner BOUCHER REALTY Mailing Address 1 35 HARP LANE City St Zip SAYVILLE NY 11782 Property Address 1 155 SECOND AVENUE City St Zip PECONIC NY 11958 Tax Map No. section 67.00 block 20 lot 16.000 Cross Street MILL ROAD Building Permit Number Cross Reference: Issue Date: 3/21/02 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) 2 c? ELIZABETH A. NEVILLE t/$ .0%� Town Hall, 53095 Main Road TOWN CLERK 14 ; P.O. Box 1179 REGISTRAR OF VITAL STATISTICS u t r Southold, New York 11971 MARRIAGE OFFICER r'' Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ;�®� _�®�i��, Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER ED�/�SI " southoldtown.northfork.net OFFICE OF THE TOWN CLERK M i ;! TOWN OF SOUTHOLD MAR 18 2002 f3� :s' T 4: �,0p9ld�Town uilding Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: March 18, 2002 Transmitted herewith is a copy of application No. 2879 for a Cesspool/Septic Tank Construction Permit submitted by: Real Boucher 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 V/e/02._ Dated OFFICE OF THE TOWN CLERK •I' /�� UUrt - TOWN OF SOUTHOLD e ® Ql/ �_ Application No.o 0-'7f ELIZABETH A NEVILLE,TOWN CLERK P.O.BOX 1179 Construction C� SOUTHOLD,NEW YORK 11971 rn 1 Alteration Telephone 0*0 ��Q�i� $10.00 - Residential v ' (516) 765-1801 _ �,o!' $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 3//y/d9_ APPLICANT NAME: APPLICANT ADDRESS: 7-//j},p� „k3. s y�rA�� SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: 4,Adi OWNER MAILING ADDRESS: 26-, ,8-1? �,e9-4/� ,5';31-7� 4/,. /).711- OWNER .711- OWNER PROPERTY ADDRESS: /3-73-- TELEPHONE SrTELEPHONE NUMBER OF CONTACT PERSON: TAX MAP NO. : Section 62 Block , Lot /4 CROSS STREET: k d BUILDING PERMIT NUMBER CROSS REFERENCE: &/7",--2141-2 1V-/P Signature of Applicant RECEIVED BY: 1 " —/� Town Clerk's Office DATE: l c,c ... LOT 17 • ` . �° `' (RES W/WELL) 1 i KCOUTYOEPARTMOPH DEPARTMENT OP HEALTH SERVICES FENCE COR .� PERMIT FOR APPROVAL OF CONSTRUCTfOPtI FOR 05/N @ 0SlEG�G 5 'e�or FAMILY RESIDENCE p�{ • �\��f- SINGE FAMILY RESIDENCE ONLY �1 : LOT 16 �� • ;1: ' (RES W/WELL) 33 O/PIPE H.aREr •©'•� � � �O -� T W 7 0 \\ • APPROVED _. ...--_. �^I \ FOR MAXIMUMBEDROOMS _. . ,V ®A��®i APPROVAL � PIRES i THREE YEARS FROM (RES LOT/WELL) G°�G�`� co .— 4 e ( F 1 y T W 7 0 n PIP ---/"\ TEST OLE Pyr �- 0 + \ / 700' / 4'C 0 10 0/ E '<CpticZ,P \ <,TF m • 9F� - 01 -1'L i-i< Cp20p41111 1,p (VLAOAN3T1 ) • 111111110, 2 111 ,� p-3' O� Ot�l� �tn� lee �O Sy F°igOO. 6 \ N. /p-G0m \ � Is p-'• -c 4`0 \ Op T:F .. T •O ( ) i0e yTN pp.°pq -\ PROPOSED - _r ,f, O� \ / �fq�p ��. \ 2 STORY RES -f< / CESSPOOL >' ON PILE FOUNDATION / \ F FL EL • 11 0' MIN GRD 4 0 �, /// \� ,�O \ Gph �� / DECK / \ \ PF LOT 33 \ (RES W/WELL) \\ \ s0 S< o wEOP• $4 =KG NE. \ RESIDENCE 7C pp-Qy 34 0' FI \\ \> '‹� ,`�� ,sem., \ // `-fop { T * ' \ / O77/ , �/ '' u o C) WELL 4 0- 4$'4 '4 ..) ;\ RETAINING WALL DETAIL O\ ..,- MOT TO SCALE{ 9 H H-13- 1 _ B .(\yJa �t�L I C) GRADE EL = �\ j�//��%icei • ! 0 `l,;m 51 COVER MAX SLOPE #3 REBAR o iz o c l` r�-+�- qI IR VF'YFn BY: