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Home My WebLink AboutZimmerman, Tom w O��pF SOUTyo! ELIZABETH A.NEVILLE,RMC,CMC O Town Hall, 53095 Main Road TOWN CLERK l P.O.Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER � Fax (631) 765-6145 RECORDS MANAGEMENT OFFICERTele hone(631) 765-1800 FREEDOM OF INFORMATION OFFICER I�COUNN,� 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. 3843 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : COASTLINE CESSPOOL & DRAIN SVS Address 1: 4225 BRIDGE LANE City St Zip CUTCHOUGUE NY 11935 Descripton of Proposed Construction or Alteration ADDITION TO EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES EXCAVATION INSPECTION REQUIRED. Name Of Owner TOM ZIMMERMAN ------------------------------ Mailing Address 1 16 CANTABERRY ROAD, APT 2I ------------------------------ ------------------------------ City St Zip GREAT NECK NY 11021 ' -------------------- -- ---------- Property Address 1 265 SALT LAKE LANE ------------------------------ ------------------------------ City St Zip MATTITUCK NY 11952 -------------------- -- ---------- Tax Map No. section 144.00 block 4 lot 9.000 ------ --- ------ Cross Street BAY AVENUE ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 12/18/08 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) L ' a *pF SOUryo ELIZABETH A.NEVILLE,RMC, CMC h0 l0 Town Hall, 53095 Main Road TOWN CLERK [ P.O. Box 1179 REGISTRAR OF VITAL STATISTICS CAA Southold, New York 11971 MARRIAGE OFFICER Fax(631) 765-6145 - RECORDS MANAGEMENT OFFICER Oly Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER C�IIIY I�,� southoldtown.northfork.net UtL — g 200$ i OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: December 8, 2008 Transmitted herewith is a copy of application No. 3843 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Coastline for Tom Zimmerman 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. Signature / o Dated - 'Off 01/(042, AO ELIZABETH A.NEVILLE V `Gy Town Hall, 53095 Main Road TOWN CLERK 1.C* P.O. Box 1179 H = Southold, New York 11971 REGISTRAR OF VITAL STATISTICS �y • �� Fax(631) 765-6145 MARRIAGE OFFICER � RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800 ��l �a FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net 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. Permit No. p Applicant Name ( oo 4j1' C e ssooal Q` D rQ I n ,00 . Applicant Mailing Address 4c05- j8eLl 046 LRAAE j!�,OrWo6cv,E A)W 093.5 Septic Tank___k,or Cesspool_ Brief Description of Proposed Construction or Alteration d 11a n — X P sw t x Pj-e62 /. Location of Proposed Construction/Alteration: Owner of Property: /()rn 2r-nm erma n Owner Mailing Address: 1(oa±Q beM A1., 1�n+ OU 67 real �Veek., A)U 1100?1 Owner Property Address: &&S , 0/+ LO-Le- L/�nP Name and phone number of contact person W1 I I - 51(x-903 - 1539 Tax Map No: Section j 4))4 Block_Qq Lot o q_ Cross Street baq P Ue, NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES S Y TH HEALTH DEPARTMENT APPROVAL I -fig ature of,Applicant Date Received by: OF LANA fPPe- / N l 0I F t%560 fOX50.0PIP0 p s 00 O f01gB a'° N deck Gtr'° @ 0 36 �0 h� VO OA 00 0� 01 0qtr \ a�' O, i r nc co N/Q/le ConC. P° O,, 6o w co 76�+' _ �. loo, 6a t coarf PI o T-11 pig. half ''tea. �_ 0° in ASP ,f . r, � �5 0. P T�ooci°° - • , ,� PLA0�1 - `C l roc CERTIFIED TO SURVEY FOR TITLE U.S. A. INSURANCE THOMAS ZIMMERMAN CORPORATION OF NEW YORK, AT MATTI TUCK TITLE NO. 8652 - 54456 LIBERTY MORTGAGE TOWN OF SOUTHOLD BANKING LTD. SUFFOLK COUNTY , N. Y THOMAS ZIMMERMAN 1000 - 144 - 04 - 009 SCALE I" a 40 ' APR. 4 1986 LOT NOS. REFER MAP OF PROPERTY OF ' LIDA BARTLEY" FILED IN THE OFFICE OF THE . SUFFOLK CO NTY CLERK ON JULY 27,19 22 AS MAP CNEirk 01.Merr ®�p� $� Prepared in accordam with the minimum N. Y.S. LIC . NO. 49618 standards for title surveys as established by the L 1.A'.L.S. and approved and adopted! P E C ON I C V E RS & ENGINEERS , P. C. for such use by The Now York State Land ( 516 ) 76 5 - 50 2 0 Title Association. P. 0. ® OX 909 MAIN ROAD