HomeMy WebLinkAboutMartz, Theodore C Jr P
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ELI7.ABETH A. NEVILLE, MMC hQ~ OG~ Town Hall, 53095 Main Road
TOWN CLERK o ~ P.O. Box 1179
H 2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS py • !•F Fax (631) 765-6145
MARRIAGE OFFICER ~ Telephone (631) 766-1800
RECORDS MANAGEMENT OFFICER ~~l ~ www,southoldtownnygov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD D ~ ~ ~ U V
TO: Southold Town Building Department JUN 2 5 2013 D
FROM: Carol Hydell, Southold Town Clerk's Office BLDG. DEPT.
TOWN DF SODTHOLD
DATED: June 7, 2013
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4138 for aCesspool/Septic Tank Construction
Permit submitted by:
Theodore C. Martz. Jr
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me. Thank you.
I have reviewed the application and loc ~on map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
Signature
Dated
• , o~gOFFO(,~~0
Town Hall, 53095 Main Road
ELIZABETH A. NEVILLE p.0. Box 1179
TOWN CLERK N = Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ~ ~ Fax (631) 765-6145
MARRIAGE OFFICER .y` ~ Q~ Telephone (631) 765-1800
RECORDS MANAGEMENT OFFICER -7~1 ~ ~a southoldtown.northfork.net
FREEDOM OF INFORMATION OFFICER 'i
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
I
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK I
lication No.
Residential @ $10 or No Residential @ $25 _ APP
Permit No.
Applicant Name ~
Applicant Mailing•Address ~ ~/9 I
d ~
Septic Tank_or Cesspool
Brief Description of Proposed Constructio or Alt lon
Location of Proposed Construction/A ration:
Owner of Property: ~
Owner Mailing Address: ~ ~ S ~i ~~`S~ ~ ~v C j
/~q ~h~'iG?~LLE
d q~'uk.~ Shy
Owner Property Address:
Name and phone number of contact pe~rso/n
Tax Map No: ction lock Lot /3 I
reet
Cross St
NOTE: LOCATION MAP MUST BE SUB TED WIT APPLICATION. NEW
TRUCTION RE UIRES SURVEY WI HE ARTMENT P R AL
CONS Q
/J
Signature f Applican at
Received by:
S.C. T.M. NO. DISTRICT: 1000 SECTION: 104 BLOCK: 11 LOT(S): 13
/R10-09-0052
BROAD1iATERS ROAD
WELL
o
CESSPOOL
O
U
O
N,'
LOT 288 LOT 289 LOT 290 /
vacaNr
LOT 287 N 66'55'40'" E
z 388.08' ~
Z 0. 126 ~rI
N Q 90.0 O
nj PaorosEO uRNLWAY 1
~ l10• O ~ I
~ O_ I
O~ 175' vaaPOSEO
~ w
sou.
x PROIR4I:D MTBt SERMCE ~ r^Qy.
LOT 299 1y~ I $~~'k I ~ ~ ~ 3 NO WELLS NSIBLE IN 7H15 AREA
ww I O ~ ` m 150
ii.
Fa'i J 150'MIN
O F~ .O 1
O n 150• ~
0. 137.0
•MIN 0. 96. ~
S 66'55'40" W 346.49' ~
WEL
~p ~ LOT 298 /
0
THE WA rER SUPPLY, WELLS ANO CESSPOOL
LOCATIONS SHOWN ARE FROM FIELD OBSERVA LIONS
REVISED f 0-31-12 ANO OR DATA OBTAINED FROM OTHERS.
AREA: 36,013 S.F. OR 0.88 ACRES ELEVARON DATUM: ~ L0A1 1' SUFFOLK COUNTY 17EpAiF'ME?;T OF HEALTH SERVICES
a+auTHORaED uTERAnav GR ADanoN To Tws wR~Er Is A NO.ABQV OF SEC BON 7709 aF 1HE NEW Y(YlK STALE EOUCA BO4 LAW. cawES a< n/rs suRl.Er ~
~ PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
MAP NOT BEAR/NG THE LANG SURYFYOPS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID 1RUE CCPY. GUARANTEES IND/CA iEO HEREON SHALL RUN 3~
ONLY TO 7HE PERSOW FOR WHOV 7Hf SURVEY IS PREPARED ANO ON H/S BEHALF TO THE BiLf COMPANY, GOPFRNMENTAL AGENCY AND LfND/NC INSBTUBOW SINGLE FAMILY RESIDENCE ONLY
L/S iED HEREON, ANO i0 Bif ASSIGNEES QF THE LfNOING MSBIUBON, GUARANTEES ARE NOi IAANSFERABLE. PALE
THE Q~FSElS Q4 DIMENSIONS SHOWN HERE0IV FROM THE PROPERTY LINES 70 B/E STRUC/UR£S ARE FOR A SPEGflC PURPOSE AND USE BIEREFORE THEY ARE BROMN
NOT /N)ENDfO i0 MONUMENT B1E PROPERTY LINES OR TO CUIDE BlE fREC BON OF FENCES AOOIBONAL 51RUC BJRES OR AND OBIER /MPROVEMEN75. EASEMENTS i0 /j,~ //RE ~ ,
ANO/OR SUBSURFACE SIRUCiURES RECORDED OR UNRECORDED ARE N07 CUARANIEED UNLESS PHYSICALLY ENDENT ON THE PRENISES AT 7Nf BME OF SURVEY C~ ATE % I~ f~
suRVEY aF: LOT 297 CERTIFIED T0: iREODORE C. MARTZ JR. APPROVED n
MAP OF: AMENDED MAP NASSAU POINr EMINENT ABSTRACT INC.; FOR AXIMUM OF BEDROOMS
FILED: AUGUST ~ 6, ~ 922 AS ~ ~ 56 COMMONWEALTH LAND 71TLE INSURANCE COMPANY;
EXPIRES THREE. YEAR`' ::~0 ~:?A""F OF A~°gOVAI~
irunre0 Are NASSAU POINT - -
owN oe SOUTHOLD NO WATER a
%BNNETH 1[. 1f0YCHUH 4S. IT~
SUFFOLK COUNTY, NEW YORK Imd Surveyins and DeaiXa 4 I~
PREVIOUS SURVEY JOSFPN A. INGEONO ~ i l~ gp~V7~ 1S I~CDCW~ - ~
P.O. BOX 9 YATTTI'UCX. N.Y. 11952
11~_. ~7 ~ ~d I ~ I
F~~E 10-31 `T^"' raoxs fast) z9e-L6e6 nx (eaL) z9e-L6e6 t j! 2~ j ~Z~
~ scALE: 1 "=40' Onre APRIL 17. 20 7 0 H , ; uc III som ,o.mwolN u,~ .«em. ar ~x~I x~~~~+v + ~ypp~r