HomeMy WebLinkAboutPenny p
10�•�oSOFFOL,�►C'
ELIZABETH A. NEVILLE /es.t4Nj
Town Hall, 53095 Main Road
1
TOWN CLERK ` y 2 P.O.Box 1179
REGISTRAR OF VITAL STATISTICS `� rry
i Southold, New York 11971
MARRIAGE OFFICER ®,PiiL ���1�, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER "'/Q! igg ��®iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER .9'' southoldtown.northfork.net
OFFICETTOF THETpFTOWNCLERK
SOUTHOLD WaWAU DISPLODSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2904 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : SAMUELS & STEELMAN
Address 1 : 25235 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
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 #R10-02-0071
Name Of Owner PENNY, GEOFFREY & DOMENICA
Mailing Address 1 570 MASON DRIVE
City St Zip CUTCHOGUE NY 11935
Property Address 1 570 MASON DRIVE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 104.00 block 7 lot 2.000
Cross Street HAYWATERS DRIVE
Building Permit Number Cross Reference:
Issue Date: 10/30/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
— ofi OFFOlit "1-.. 019°Cd/
11
ELIZABETH A.NEVILLE 1"��0 G1Town Hall, 53095 Main Road
TOWN CLERK % ti - % P.O. Box 1179
`y, Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ® 0 Fax(631) 765-6145
RECORMARRIAGE
S MANAGEMENT OFFICER y�®l ��®����, Telephone (631) 765-1800
FREEDOM OF INFO O&+T FICER * ,,,s" southoldtown.northfork.net
,----,7
- a , -.....�
\\i, OFFICE OF THE TOWN CLERK
11 �c� 2.,,,,z TOWN OF SOUTHOLD
TO:" Tov�'.{ - =--Suthor Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 27, 2002
Transmitted herewith is a copy of application No. 3021 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Samuels & Steelman for Penny
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:
./V--
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION RE•UIRED. �e' �`
,'
71‘6-1e/'1.9/ ,= '
Signature
,1/3 0/;:a___
Dated
OFFICE OF THE TOWN CLERK ���',, •••••,�
TOWN OF SOUTHOLD �,• ��1�rFOL �►
FJJ7ABETHA.NEWT JP,TOWN CLERK L44 O ; Application No.
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 v •
Alteration
Telephone �Qe' • $10.00 -Residen'tial
(631) 765-1800 - 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 9/as-/O-
APPLICANT
/as-/O
APPLICANT NAME: 7.11fmaS C Sakvi,U.Q.LS — sawue. L&
APPLICANT ADDRESS: RS (3'S ,v' '
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: Ges)q- 0 ' boi'I'l°.n1`c.0. ?e.nn
OWNER MAILING ADDRESS: AnAx,L5, Sb rna.1 L
OWNER PROPERTY ADDRESS: 5--30 Rason, t:v
C.,u_i-Etivvb8u4a. W1
TELEPHONE NUMBER OF CONTACT PERSON: 73q-(.®40S-
• TAX MAP NO. : Section {)H Block -7 Lot
ra
CROSS STREET: itIA)62.7174/1..›0
BUILDING PERMIT NUMBER CROSS REFERENCE:
i
1, Pi 7
Signature of Applicant
J'1
RECEIVED BY:
Town Clerk's Office
DATE:
SITE DATA
e ,...-- 1t ,--•, I ..- ,
..•-••• SCTM# 1000-104-7-2
PROPERTY PENNY RESIDENCE - ‘.• - . ,
--
AORESS 570 MASON DRIVE '--
CUTCHOGUE,NEWYORK --;
SITE: 53,948 SO FT 1 2385 AC .
AREA
ZONING R•40
FLOOD X c
ZONE ,
Land now or formerly of:
Charles Boyer, Jr. SURVEYOR JOHN C EHLERS
RIVERHEAD,NY
SERVED BY LICENSE 0 50202
PUBUC WATER DATED 142-2000
• CD • NOTES, FOR ELEVATJONS AND
TOPOGRAPHIC CONTOURS REFER TO - CO
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MAPS OF THE FIVE TOWNS. P
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net=MOH DAMP AP .
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• 1P-AcHINIs FOoLS SERVED BT
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• . EXPANA)ON -.. roprr .
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. NAM DOOMPOOP ATM RAMON&WACO
: Abandonment of uxist g sanitary system -:.
- / , ,,, •
, to be witnessed by Health Department n' - . . .
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_ ----------------,..,— 1.---BUILDING MALL •
SUFFOLK COU N'i'Y 0 EPART 4,1 E:A% Cf; H Ei4L,vi 41 D E ilV I C E S / / .PR•JE
. PROPOSED GRADE LINE ELEVATION 1.:9.5 FT.
, / /7 / ••- .,,
PERMIT FOR APPROVAL,OF-CONS Rr.oCT.0 .
, -•- -.--• I' MN., 2' MAX .
SINGLE FAMILY RESIDENCE ONLY --/— •cH ECK
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L. - .... I/.4•"/FT. ••••• DATE:
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SITE PLAN .... i
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