HomeMy WebLinkAboutMartz Theodore OFFICE OF TIlE TOWN CLERIi
TOWN OF SOUTHOLD
ELIZABETH A. NEV]I l ~; TOWN CLERK
P.O, BOX i179
sOUTHOLD, NI~W YORK 11971
Telephone
(63~) 765-1800
TOWN OF SOUTHOLD
Application No.~
ConstructiOn .
Alteration l/
$10,00 - Residential
$;15,00 - Non-Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE July 17, 2003
APPLICANT NAME:
APPLICANT ADDRESS:
SEPTIC CESSPOOL x
Theodore C. Martz Jr.
145 Ryerson Avenue
Manorville, NY 11949
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: Theodore C. Martz Jr.
OWNER MAILING ADDRESS:
145 Ryerson avenue
Manorville, NY 11949
OWNER PROPERTY ADDRESS:
970 JaCKson's Landing
Mattituck, NY 11952
TELEPHONE NUMBER OF CONTACT PERSON: (631)-878-8443
TAX MAP NO.: Section 113 Block 06 Lot 02
CROSS STREET: Mill Road
RECEIVED BY:
TGwn Clerk's Office
DATE:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature
S.C.T. kl. NO. DISTRICT: 1000 SECTION: 11,] BLOCK: 6 LOT(S'): 2 [Lt'V. 27.0.+ ELEV 5.0+
RECEiVEO
SUFFOLK COUHTY! o.~'
HEAt.TH SERVICES LO~-
~OOIMAR I0 AII:Sb
: SAND WATER
r RO VAL
S 0t'~'80" g ~ 1~.~'
DWELL ~
W/PUBLIC WATER ~/~ ~CHARGK
~ 12.0) ~ 11 ~)
~o)
jAC[SON'S (so') NDING
MIIJ. RO~
W/PUBL~ WATER
~g WA~R ~PPL~ ~LLS AND ~SSP~
L~A~S ~0~ ARE FR~ FIELD ~RVA~ONS
ANO ~ OATA ~rA/NgO ~ O~E~S.
AREA: 25,600 S.F. OR 0.59 ACRES ELEVAnON OA~: __~ ..................
UNAUTHORIZED AL~RA~ON O~ ADDISON TO ~IS SURLY IS A ~OLA~ OF SEC~ON 7209 ~ ~E NEW YORK STA~ EOUCA~ON LA~ COPIES OF ~IS SURLY
MAP NOT 8EARINC ~E LAND SUR~YOR'S EMaOSSED SEAL SHALL NOT BE C~SIDERED TO BE A VALID ~UE COP~ CUARAN~ES /NDICA~D HEREON SHALL RUN
ONLY TO THE PERSON FO~ ~OM ~E SURLY IS PREPARED AND ON HIS BEHALF TO ~E ~E COMPAN~ GO~RNMENTAL AGENCY AND LENDING INS~TU~ON
LISTED HEREON. AND TO ~E ASSIGNEES OF THE LENDING INST[~ON, GUA~AN~ES ARE NOT ~ANSFERABLE,
THE OFFSETS OR DIMENSIONS SHO~ HEREON FROM ~E PROPERTY LINES TO ~E S~UC~RES ARE FOR A ~ECIFIC PURPOSE AND USE ~EREFORE THEY ARE
NOT INTENDED TO MONUMENT ~E PROPERTY LINES OR TO GUIDE THE EREC~ON OF FENCES, ADDI~ONAL S~UC~ES OR AND OTHER IMPRO~MENTS. EASEMENTS
AND/O~ SUBSURFACE S~U~URES RECORDED OR UNRECORDED ARE NOT CUARAN~ED UNLESS PH~ICALLY E~DENT ON ~E PREMISES AT ~E TIME OF SURLY
SURVEY 0~: LOT 9 CERTIFIED TO: THEODORE C. MARTZ JR.;
MAP OF: JACKSON'S ~ND/NG
FILED: MARCH 28. 1969 NO.5280
SITUATED AT: MA~ITUCK
mo~ Or: SOUTHOLD
P.O. Boz 3, MatUtaek, ~ ~o~ 1195~
~o~ (e~t) ~ee-~s ~ (~) ~-t~
FILE ~ 22--209 SCALE: 1 "=~0' DATE: FEB. 22, 2003 ,. Y. s. LIC NO. 50227 -' mataainI~ ~e meo~ of Robe~ J. Hennessy