HomeMy WebLinkAboutPotorski ,,"''SU%FO`,'
ELIZABETH A. NEVILLE1 Town Hall, 53095 Main Road
TOWN CLERK y 2 P.O. Box 1179
V46
r� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS G al` o Fax (631) 765-6145
MARRIAGE OFFICER ,L
RECORDS MANAGEMENT OFFICER �:!y�QiNg Oft
#0.0/ Telephone (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. 2855 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : H. J. R. MODULAR HOMES
Address 1 : 1691 COUNTY ROAD 39
City Si Zip SOUTHAMPTON NY 11968
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 #R10-02-0127
Name Of Owner POTORSKI, JOSEPH
Mailing Address 1 34 RIDGE ROAD
City St Zip FRAMINGDALE NY 11735
Property Address 1 910 SHIPS DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 3 lot 25.000
Cross Street BAYV I EW ROAD
Building Permit Number Cross Reference:
Issue Date: 7/23/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
• r ii OFFOLt:-.._ , g55---
ELIZABETH A.NEVILLE / Gla: Town Hall, 53095 Main Road
TOWN CLERK t o - % P.O. Box 1179
t Southold, New York 11971
REGISTRAR OF VITAL STATISTICS % ow: CPA, , ** �� Fax (631) 765-6145
MARRIAGE OFFICER 16 �1
RE�"'ORDS MANAGEMENT OFFICER -__-®1 Zig *O®" Telephone (631) 765-1800
.,,,, FREEpOMVI OF INFORMATION OFFICER ������,�r�,, southoldtown.northfork.net
/LPJULi5 . OFFICE OF Zoog , TOWN OF SOUTHOLD
TO: Southold Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 15, 2002
._ Transmitted herewith is a copy of application No. 2960 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
H J R Modular Homes for Joseph Potorski
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.
„A.66free44A)Vr-..,—_ f/7/-4 .
21.4e,..44 Af./ .i.:,..
Signature
e)7/10/02—
Dated
7 / dzDated
Y ' '
1
OFFICE OF THE TOWN CLERK ,• r, ,rrrn,,,,.'�
RT.rrABETT3A.NEVI LE,TOWN(i.FRKTON OF SOUTHOLD
1•�6�•�oSVFFOLkccr • Application No.
P.O.BOX 1179 44
Construction
SOUTHOLD,NEW YORK 11971 Z
v •
� y� Alteration
Telephone ,z4.10
,� �,•• $10.00 -Residential
(63-1) 765-1800 dol �►���
$25.00 -Non-Residential
TOWN OF SOUTHOLD
e •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. .
Fee '$
DATE -] I
APPLICANT NAME: 1-1.�, R dv161 U 4p. omv S (,U/c.t_/per /0014/4 iv
APPLICANT ADDRESS: /69 l Ceti',fry 1; n 3
cov 79-s►&. P-7-lN Al Y I I 7 6 9
SEPTIC ✓CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION /UELk Rgsb,
4- v is. E.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: :3 aS P tt Po ra R.S K
OWNER MAILING ADDRESS: 3(4- t I.Dcv6 1kp Fehkwt.il./cI A.Le
OWNER PROPERTY ADDRESS: 9 to S/-f- 1 1`�Sb,
coU-1-1-td
TELEPHONE NUMBER OF CONTACT PERSON: 631 , 2-83 1 44 /
TAX MAP NO. : Section /D o d Block 7 `j Lot 3 --Z_ s-
CROSS STREET: j3F 'ul r5-0,) R D
BUILDING PERMIT NUMBER CROSS REFERENCE:
pP
Signat of Applicant 9
RECEIVED BY: )e
Town C s Office
DATE:
SORRY OF LOT 4 N
MAP OF SAYVI Ek 1 V'OODS ESTATES _
FILED SEPTEMBER IG, IG10 FILE No. 5520
`A' f S
SITUATE: 5AWIEN V`� S
TONN: SOUTHOLD
SUFFOLK COUNTY, NY
SURVEYED 06-26-01
CERTIFICATIONS ADDED 01-25-02
prop action 06-13-02 CI
cam,-, f1a
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SUFFOLK COUNTY TAX # - y ��c.,.
1000-11-3-25 co Fri r� r—c-_,
i r-1 r-_ o- sM C`-1
r , t .
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IOSIEIPII3[POTORSII�[,JJR. K- �� `_'
SUZANNEPOPORSIII[ c. -
1PIEQ:ONIC ABSTRACT,INC. a t, —
m
N —I 17
well
,
j\ O n Dwelling Test Hole
v1.
a ! OC-OS-02
S63°55'50"E
175.00'
W \\well
Dark
t W , ` •
G� O OL Brow
I/ (1 el 23' Sandy
j / �'' I\24' Loo
Cl) ?" �t t!i At i 0 TEST Brow 1.
s • ,-/-
Lr) lour HOLE X
I (� tlI ell CA ML
Neal t..i �" E- le, 0 U /' W O Cp Ntt `2' ` silty
I [ r Q O ,';,., 37.0' t y/� 3
t b^xri i°r r F--n- ^y ' �> ,� r �Q till Brow
I T / r U./_I /' iz P� N SM sntu
I 6=7 a Q �Ili I N o v 50' ,' o ••IQ,G " 6.
F- -- p z0 N D to m
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S
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4^9 � 1 5 2 1. L.P` I (0 Pale
r
3 ,,";:s '‘.1
Q 2N' I 9IJ Q m t}0' I 3 Brown
C.4 "' ,< X 1 ID L. ®i l z, C , sw Fine
iLO
ez r-.i . I IL O (EP 24.6' ll 7 To
((�FFWj��. �well t a Fji g.g• I 1 coarse
'3P D tt Q I'•1 a 0 PROPOo.ev vwvENAY sand
I icy 1 c`: I 210'
• 9 Ul 44_ — _ `a
o ' � CL. c✓) t 0 , 8
N 1 •
:- �' t rd
ds
Q ® ts�j ® ,t el 24' In Weil
!WWW '1
04 • \ /+'� — 5 x Fe x %—k o s A x . CHAIN LINK FENCE x /%� nnl
LA —xx—x_.'` 0 el 24' NOTE.no water encountered
+ N64°57'20"Ws el 24'
LV �V
NOTES-v.- --------.__._... , •
ill 184.95' %
\ \ Gp O IT1 ,/ I d 'noU eb or''orkg a,cera eoi,,o 7.,,,A-07.;:o4'017,
• MONUMENT FOUND =
moiaticn or secuan T�cq -di�lson oe
\ Vacant � % � � New York State Ed/cation Law'
01
LO y
o PIPE FOUND ///A��i I w�kee 'ems o ig the
of the landthus surveyor's
�• �' x stanped seal stroll be considered to be valid true
O.(' p� ��d, t copies
`. Q 1'' N C. Eye / ` •Certrlications indicated hereon signify that this
•
I survey was prepared H accordance with the no-
ELEVATIONS REFERENCE SUFFOLK COUNTY TOPO MAPS •�COe .`o F'f' by`t o Nen Yo k State Assocl r ProfProctice For Lord Svrveys essional
) •`- �. . Land
to[hep n tar Shamrtificarvons shall to only
C� \ aid on his person
o rhe m the
eomp�goIs prepar6
d
SETBACKS PER TOWN OF SOUTHOLD TOWN * 1" ' �_ v
tai agency and I1Olg ro=ll Ils!l Fereon ord
A *, �( to the assignees of the lending Institution Certifico-
' ° J� tions are not transferable to adttlonol institutions
GODS FOR NON-CONFORMING LOTS rRl
AREA = 21,822 5F OR 0.50 ACRES ' e t �? ►; '' Ocr F weld �� I
%• O as 11LA`7 C. EHLERSL t. , f�l�` E �L ��1 a.
...•/1/49 "u.'i2 uP-•�0 6 EAST MAIN STREET N.Y.S.LIC.NO.50202
5
GRAPHIC SCALE I"= 40' to
gar.°s� •
RIVERHEAD,N.Y. 11901
369-8288 Fax 369-8287 REF:\\Hp server\d\PROS\01-206a.pro
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