HomeMy WebLinkAboutRoberts JlFFOL,�'
ELIZABETH A.NEVILLE ���ti� Gy Town Hall,53095 Main Road
TOWN CLERK o P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS %.‘r
w Southold,New York 11971
` ® 1 Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER y_�®1 � II1 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - r,I, 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. 3109 R Residential x Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ROBERT'S CUSTOM HOMES
Address 1: 50 DIANA COURT
City St Zip WADING RIVER NY 11792
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR ONE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-03-0094
Name Of Owner ROBERT'S CUSTOM HOMES INC
Mailing Address 1 50 DIANA COURT
City St Zip WADING RIVER NY 11792
Property Address 1 655 BAY AVENUE
City St Zip EAST MARION NY 11939
Tax Map No. section 31.00 block 10 lot 13.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 10/20/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE - ���h`Z`®itV %%\ Town Hall, 53095 Main Road
TOWN CLERK % p - % P.O. Box 1179
ti 2 ; Southold New York 11971
REGISTRAR OF VITAL STATISTICS y� i '
MARRIAGE OFFICER O I% Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ';_4# 0*ole Telephone (631) 765-1800
;FREEDOM OF INFORMATION OFFICER =O'� �,. southoldtown.northfork.net
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OCT m A 2003 H OFFICE OF THE TOWN CLERK
1 TOWN OF SOUTHOLD
C. - F
T` r , _r)_ j
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 1, 2003
Transmitted herewith is a copy of application No. 3240 for a Cesspool/Septic Tank Construction
Permit submitted by: ,
Robert's Custom Homes
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 1 ation map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: ✓�/i�✓/ ?1_
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Signature ‘44
,' F. ? o2C)0 3
- Dated
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ELIZABETH A.NEVILLE ail i$` • 4 �; Town Hall, 53095 Main Road
TOWN CLERK ; p , P.O.Box 1179 a.
REGISTRAR OF VITAL STATISTICS ti 2 Southold, New York 11971
MARRIAGE OFFICER - G ` 71�, • . Fax(631) 765-6145 .
RECORDS MANAGEMENT OFFICER \ywe ,a O'1 Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER 1 ���""'1 southoldtown.northfork.net 1
,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT .
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 or Non-Residential @ $25 Application No. If 0
Permit No.
Applicant Namc j 6i rLl 5 Cid 14✓} >41 C S
Applicant Mailing Address JVD .et e 0
Idad i; ZivP K Y //790'--
Septic Tank V or Cesspool ,�
Brief Description of Proposed Construction or Alteration /it° eOi') �G �U
Location of Proposed Construction/Alteration:
Owner of Property: ]D b_e n 5 Cad ilie5
-- Owner Mailing Address: 570 /On et
aiad rt. /),ved /0-y / /2Q2-
Owner Yroperty Ades: Ion_ Aft')U_ c- //
H57-- /ii 79-R/o.✓
Name and phone number of contact person o -I Cj',_c&4 6160/7 f 72-7-2Tax Map No: Section / Block /® Lot 43
_-Cross Street /4,9/ s) :
NOTE: LOCATION MAP MUST BE SUBMITTED v----„,- ,—WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HE DEPARTMENT APPROVAL
Signature of Applicant
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Received by:
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F I am familiar elf lrr-4-STANDARDS FOR APPROVAL -- —
AND CONSTRUCTION OF SUBSURFACE SEWAGE SUFFOLK ;N Y DE?ARIV i4''`OV"-'AT L IE-H S IR ICES
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
`J` and will abide by the conditions set forth therein and on the = Y , r� ,t�,;
. ' ii\ I ',, n permit to construct.
FERMI if':.,JEi AP? :CP': L O�+�: _.•�gSTREJCTION R A
f� 6MIGLE yg`lkif;af1t
I5. hk1FE ONLY
1F
• QJ' The locations of wells and cesspools DA•8Cl�lS-E,5• HS REF.NO,a•-• -'cG9l.. ' '
4c& shown'hereon are from field observations IV
�. _ and or from data obtained from others. APPROVED__ ... a. . _::��.�!�SW*r!
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and
0 , ., 0
FOR Y AXa1UM OF EE f OMS -k::. N
T EXPIRES THREE YEARS FROM DATE OF APPROVAL ag `-
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P , e' �� �` eel sw i 4, '�_Iya el K <<'% 1 . N .S. LIC. NO. 496/8ELEVATIONS ARE REFERENCED o OttI y '..TO AN ASSUMED DATUM• e
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AREA = 41,608 sq ft 1230 TRAVELER STREET
SOUTHOLD, N.Y. 11971
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