HomeMy WebLinkAboutPetikas OFFOLit
ELIZABETH A.NEVILLE Town Hall, 53095 Main Road
TOWN CLERK 1 o - ik P.O. Box 1179
y Pr, t2 t Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS
MARRIAGE OFFICER `` y ����, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ;_'1491 . ,'� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - rr southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3047 R Residential x Non-Residential
Fee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : THEODORE PETIKAS
Address 1: 225 STEWART AVENUE
City St Zip BETHPAGE NY 11714
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 #R10-02-0019
Name Of Owner PETIKAS, THEODORE & MAIRA
Mailing Address 1 225 STEWART AVENUE
City St Zip BETHPAGE NY 11714
Property Address 1 1125 GARDINER'S LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 8 lot 46.000
cross street
Building Permit Number Cross Reference:
Issue Date: 6/11/03 Elizabeth A. Neville
Southold Town clerk
(TOWN SEAL)
inut
} ELIZABETH A.NEVILLE ;�� : O1
; Town Hall, 53095 Main Road
TOWN CLERK % ® - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v. els Southold,New York 11971
` ® 1� Fax(631) 765-6145
MARRIAGE OFFICER 456 ®���� Telephone (631) 765-1800
(RECORDS MANAGEMENT OFFICER �_ 01 jig �� �,, P
'FREEDOM OF INFORMATION OFFICER _ ,�' southoldtown.northfork.net
MAY 2 2 2003 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: ` Linda J. Cooper, Southold Town Clerk's Office
DATED: May 22, 2003
Transmitted herewith is a copy of application No. 3171 for a Cesspool/Septic Tank Construction
Permit submitted by:
Theodore Petikas
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: _ _ 'i
7/te.„/...C11�
Signature
4015/2-. /0.3
Dated -
oil OF FOLA.
ELIZABETH A.NEVILLE ���`�` Gd Town Hall, 53095 Main Road
� P.O. Box 1179
TOWN CLERK co
y = Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ‘`%1e. .�C
• • MARRIAGE OFFICER
�� Fax(631) 765-6145
•
RECORDS MANAGEMENT OFFICER ,°i# #°.°
Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER = ' 011southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 jor Non-Residential @ $25 Application No.
Permit No.
die_
Applicant Name
Applicant Mailing Address gas 51" Vf-
3e`Np&q? J
Septic Tank \/or Cesspool � �
Brief Description of Proposed Construction or Alteration (N W R.0-e-
Location of Proposed Construction/Alteration:
Owner of Property: --110 M ela PH ka5•
-- Owner Mailing Address: Q9-5 5--0uJCt"15
✓�
501)Dale KY
Owner Property Address: C1 Q,L,(l-e,r5 Lone. 1 3U.411.ot -
Name and phone number of contact person Pen(IL( LUn
Tax Map No: Section 70 Block Lot ('
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signature of Applicant Date
Received by:
"m
9 •
-SURVEY EY OF LOT 24 SEPTIC. DETAIL •
not OF FAIRVIIEV4 PARK, SEGTION I to scale
N
PROPOSED
}}�� ��+(�) WELLING
SITUATE: SOUTHOLD MAXMA% SLOPE 5%
proposed
TOY�NN: SOUTHOLD NEAR SEPTIC o'
�� el 6.5x 1?' -.*E
1iV� Y NY min
SUFFOLKCOUNTY,1 well eximtei'9�1� dsLS 5 i5v3= cover inv... 5.B
min- i0'in�•' 1000 gal. I 1
5.0 septic min. Pitch
0 110015}9 ii• tank 1/4� Per ft S
well
SURVEYED 12-26-OI e' tl;a1
AMENDED OB-I61-O2 EL= 3 C
min, 2
separacl0n
SUFFOLK COUNTY TAX #
ground water Ems= I
IOOO-70-8-46
Test Hole
CERTIFIED TO: DWELLING 8-27-OI
BMA CONSTRUCTION Nel!
SUFFOLK COUNTY HEALTH DEPT. LOT Loaf
OL
NUMBER RIO - 02 - OOI61 1.5
I1 5
cesspool LOT�7Brown
'—\ 2C. Sand SM
2 5
p� _ Pale
DWELLING S78 22'SO E e a n
w �� DWELLING Pro SW
1 g,
t N �o� el 62' I !�-AGE 1 g�! Coarse
`� J Sand 4 4.
���,4PROPOSED 3 } 5 � - •
2 1I WELL,,
osu CHAIN LINK FENCE - ?r of 77
METAL FENG 1
_ Y ; OLK COUNTY DEPARTMENT OF HEALTH SERVICES
Water
z PR eh 55 — RMIT FOR APPROVAL OF CONSTRUCTION FOR AIn
PaleSW OPOSED DRI l — _I SINGLE FAMILY�2E51bENCE ONLY Brown
F'^e
Q / t _+:70:.7./
\S ! \ 0 i A To
I / / } I (� J l_ Goorse
/ I I J LO /3T' \ ATE f13�`� R 0,p(k3 - -O�ak�l Bond I
I _ o / -'-` I I Wii: 24 „ �� APPROVE® * I
pitii / 1 7��L= oc<ing cast .iron 81 ''" \ FOR MAXIMUM OF- BEDROOMS r I
cover to ii
cesspools I / / I grade �' I EXPIRES THREE YEARS FROM DATE OF APPROVAL '
nO I I 9a�: �I �'
en 40' I I s r c Q �5 4 - Lk• 6'� u 1 r'� l Qc$
r-.i ` r — LOT t •: I` i►1 c_a a+ �' ��� I
s, O I I (�P\ C 23 I
en / Op��� I'>-' : j ,,,i C_ s�c„,t-- 1
VACANT I ~~ I e P\ w ce=scocls
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/ I _ _ -0:.--' tD (1.-F\ 5,'-� 1...� "-• ' i
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NOTES: `e! 3 3 I CONT - _ - . 7
• MONUMENT FOUND /N77°11 230"W - -
PIPE FOUND / �J �V� 168 t : ,,,a_t,,a.,op -atr; ,00dpttan to o sutiey 1
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/ VACANT I �smT�e.zeal tion to ns� ed to ea vatoe o-,e
AREA = 21,504 SF OR 0.461 ACRES / YF1e93
.Y ert tications 1,-61.a'ect hereon siyn,fy that"
,iy
LAND !r, c, � ,..r,.e,was pre pored.n accorednce..Sd the e.-
NOW OR •,,1 2lo de of ct.ce for Land Su-vey odooted
ALICE FORMERLY �' tri too Nen York 5tattea s.oc`ato[n of Fro e
PROPERTY ZONE R-40 (NON-CONFORMING) J DART ASSET MANAGEMENT TRUST \# G. Ey4' fr�4 •L'`..:-?-=;;:t: "h`m``;ZZ�'' 1
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FLOOD ZONE AE (EL S) '
V*1 ix I yI� II-t " •,y �I It�,lv50 G.Y. OF GLEAN FILL REQUIRED , - CFIN a -�It a > '1;'1.
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C�RAPHIG SCALE I"= 30' wQ��t RIVERHEAD,N.Y. 11901 j
i _ 369-8288 Fax 369-8287 REF.—\\Hp server\d\PROS\01-314.pro 1
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