Loading...
HomeMy WebLinkAboutPolywoda %%fFO4 o, � ®C ELIZABETH A.NEVILLE ; i �� Town Hall, 53095 Main Road TOWN CLERK ® P.O. Box 1179 REGISTRAR OF VITAL STATISTICS ,,i Southold, New York 11971 MARRIAGE OFFICER ,fs �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �__ 1 agg 4;,I Iii Fax (631) 765-1800 FREEDOM OF INFORMATION OFFICER , 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. 2988 R Residential X Non-Residential Fee $ 10.00 septic x Cesspool PERMIT ISSUED TO: Name : MICHAEL PISACANO Address 1: PO BOX 1931 City St Zip SOUTHOLD NY 11971 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 #R10-02-0086 Name Of Owner POLYWODA, JOHN Mailing Address 1 MAIN BAYVIEW ROAD City St Zip SOUTHOLD NY 11971 Property Address 1 SHEPARD DRIVE City St Zip SOUTHOLD NY 11971 Tax Map No. section 78.00 block 1 lot 17.000 Cross Street GLENN ROAD Building Permit Number cross Reference: Issue Date: 2/18/03 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) r y ,iii.... C3 opo coa ELIZABETH A.NEVILLE ����� y Town Hall, 53095 Main Road TOWN CLERK % o P.O. Box 1179 co REGISTRAR OF VITAL STATISTICS Southold, New York 11971 a MARRIAGE OFFICER 1i � � Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER =_Wel jig isS, Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER ��� southoldtown.northfork.net OFFICE OF THE TOWN CLERK 2_ 1 t(7T ) TOWN OF SOUTHOLD TO: Southold Toyyn B ilding Department - FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: December 27, 2002 Transmitted herewith is a copy of application No. 3109 for a Cesspool/Septic Tank Construction Permit submitted by: Michael Pisacano 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 Dated OFFICE OF THE TOWN CLERK , ,O�� uur ,G r"" {, TOWN OF SOUTHOLD �J CQApplication No.rIO i ELIZABETH A.NEVII 1P,TOWN CLERK P.O.BOX 1179 Construction LV SOUTHOLD,NEW YORK 11971 : p • T ; Alteration Telephone 0,�� ��i• ' $10.00 -Residential I (631) 765-1800 �l, �'�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 /V-- .27- G Z_ APPLICANT NAME: 0(1\ C ISA- -".1 APPLICANT ADDRESS: C 0 , 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: a -a- \ C— `-Pore-y t,1CA OWNER MAILING ADDRESS: \()'\ k•Je�w 2� OWNER PROPERTY ADDRESS: WE- TELEPHONE �P,4ZG V211/L-� S TELEPHONE NUMBER OF CONTACT PERSON: TAX MAP NO. : Section 7d Block / Lot /7 • • CROSS STREET: ' a LEimiiti Te- BUILDING PERMIT NUMBER CROSS REFERENCE: Ci(-/\ Signature of Applicant 2-\S) RECEIVED BY:`-0 . Town Clerk's Office DATE: t)--(X1(/ � X1( • SURVEY OF LOT 42 r , MAP OF NEST GREEK ESTATES N Y FILED AUGUST Ia, 1163 FILE No. 3848 SITUATE: SOUTHOLD W s E TOWN: SOUTHOLD SUFFOLK GOUNTY, NY i SGT# 1000-7S-I-II SURVEYED 12-06-01 ---- MAP AMENDED. SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES prop. Vise. 03-27-02, 04-001-02, 05-16-02, PERMIT FOR APPROVAL OF CONSTRUCTION FOR A 10-201-02 �\o SINGLE FAMILY RESIDENCE ONLY =TIMED TO: �'e ������ / DATE t Ir-7-©2- HS REF.NO. 1P ICS-OP-o0 6 e� IE Trak ECILAVAS ,,.,,_ ,r APPROVED.. .. .. . . ... Aral.._4.0 P°ELL]KLAVAS �CICE CgND /.� oP FOR MAXIMUM OF 67 . .�r ODMS J DART 5s /RM�� EXPIRES THREE YEARS FROM DATE OF APPROVAL '' WCF1 NG N gGFMENT �=n�-po•2A-R.`� 'w�- CO trtT� 2 /.D., c,-(:),!,::: �' TRUST pa%a(L --co ( 5s vl+Nc-C- o'F- r.-.D L J F — -c. /4-30P12-01 ' - .1, OP ,/D D NoW R t,,- .. --.;1.•_- / ‘el( RT o -- -) c: " ,---Z.a n M Qtr: w Me a .S`�' Ass,..T Fon -su /,?• *** 30 4E YA MAkA EC r o� 't :=� .,.:\i .! ? W f-,-),--,...,-'� �, NT �RMJ MINT T'QUST ° `` w o H o** 37 1) • ice_ 1/4 It Q Isr• '-C., GRAN g '* ' s! - - 4/ pR Op .� 36' e/14. 0 4 UT O 4/ sHe�r ) •,� w� no 0 T A 0 0 c'tincpat p c 1 I 1.0`-,--,,,,;\ ,-(1 --------............................................... - - V o 0 V Q b'deep �- v SO p 8'dfa ea �P J o , -- --___ ,_ --,---_-_ ,H9 Ev , � Pip' K ' X` - - - kll WO. .p. rte' P05ED '� ° � 0 - PRH0ilS, _ -- N --\ , ri - 201 la, LOT POgEv PORGN, rn ubll4water �r pR0 m p Z0 ` 0 / CN o'tiG TEST HOLE�o� A1 ti,,t, ' Qi" ' p O _ \T Y �, ALF L0� .� ''i ‘• A2 Test Hole % •��ti'•.- - �� ,s 3/22/02 N/ 4 S Q��jIk°'� ��� o Brown O Lucy OL Loam 2 • 1151 Polo SP e /3• Brown Fine ToMedium a ' I.00' Land (W{, ' .11 8 QP Water Y In Cf Pole pit/ 1/i � zo , 14 Fine 1 To SP �V Mp�IA Medium - ` ,ice• 'r- Sand �` � \W q 17' / ____....... ��'�Q4-oC. EA, �O; •i \ 'Ihmehori:ee alteration or amnion to a survey $co s ,'/11 4s .6• \ map boa-mg o ikensod imd svveyore zeal b a NOTES: - i J C 11 f ; violation or section St did+cotion of tri he yj 1�• �;Z�i. L •� ,y; •a,y oopias from tae origt ai of surveyor wror9 ■ MONUMENT FOUND \ •li\.,,"y 'f . 7� ' mo ked ita on original of land a.eyo 11;."'" ,;.). , e moped esoi soon be ooroworod to eo�oi�wo PIPEFOUND •i '4.--1.4,;;;,.:=7:---- Q •Lertnicotimis Ndicdted hereon nkyiny!hot this O, \ O ; rvey nos f Proatla N accordmice nih do ted ' btbvd Lode of Practke for Ldnd Survey9 adopted //��II�� ttb New York State Assocbtbn of Pro/dssloml ..„,6,1 0202 ��I p, �L �r5or for d horthemaoi ny ttn pored AREA = 27,701 5F OR 0.64 ACRES `AND 5V 0 on lie o t�„itlet�a�ffea ofl „�aI�"- to the aeskf0oe of the 100005 4estitntion Lertmco" SEPTIC, SHOWN FOR THIS LOT 15 PROPOSED tions are not transferable to additional Nstitutions NO PHYSICAL EVIDENCE OF AN OLD HOUSE JO H\ C. E HLE S LAND SURVEYOR OR SEPTIC, SYSTEM ON THIS LOT 0. 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 GRAPHIC SCALE I'i=30' RIVERHEAD,N.Y. 11901 REF.\\Hp server\d\PROS\01-303.pro , 369-8288 Fax 369-8287 4• ia,�,aod, i•se.aei�+ ,y,,.e�er��,-morn 4