HomeMy WebLinkAboutClark, Michael ow iii
��,O�0 FO�,rCOG.
JUDITH T.TERRY ��_� yL Town Hall, 53095 Main Road
TOWN CLERK ; H Z P.O. Box 1179
0err
REGISTRAR OF VITAL STATISTICS ; Southold,New York 11971
Fax(516) 765-1823
MARRIAGE OFFICER "NA,
��� Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER 4
FREEDOM OF INFORMATION OFFICER • go'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1701 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : THEODORE C. MARTZ JR.
Address 1 : 145 RYERSON AVENUE
City St Zip MANORVILLE NY 11949
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. SCHD REF. #R10-96-0112
Name Of Owner CLARK, MICHAEL
Mailing Address 1 28 ROLLING RIDGE ROAD
City St Zip NEW CITY NY 10956
Property Address 1 500 JACKSONS LANDING ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 113.00 block 4 lot 7.000
Cross Street COX NECK ROAD
Building Permit Number Cross Reference:
Issue Date: 7/14/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
01 <5)0So
JUDITH T.TERRY �I4 G't1 Town Hall, 53095 Main Road
TOWN CLERK ; y P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O ��
MARRIAGE OFFICER L y
Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER -�19,( *goo'01- Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER % ,,.°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD D V
TO: Southold Town Building Department ' ' sw
FROM: Linda J. Cooper, Southold Town Clerk's Off ce BLDG
DATED: July 10, 1997 NOF SOUTHOLD otb
Transmitted herewith is a copy of application No. 1771 for a Cesspool/
Septic Tank Construction Permit submitted by:
Theodore C. Martz Jr. for Michael Clark
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.
Thank you.
Linda J. Cooper
* * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments:
ignature
1 1 << i41
Dated
f �
OFFICE OF THE TOWN CLERK c0Four
`,�
Town of Southold �� -:t
Judith T . Terry, Town Clerk +� Application No.�J
..�.
Town Hall, 53095 Main Road ��.-'��: Construction
�n
P. O. Box 1179 � '- t ' Alteration
Southold, New York 11971
O
Telephone xt � Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
• SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
q /t7 q
�. DA j
APPLICANT
40,9e6' eI ANT NAME:
APPLICANT ADDRESS: 7\ ir�� ���P
/Wide/ ›‘11 //CI./
SEPTIC CESSPOOL.-%6
DESCRIPTION OF PROPOSED CONSTRION ALTERATION
i2Oui /JC, /e-ea
fret< )()//-d9 1,4ditie47S
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRU TION OR ERATION :
OWNER OF PROPERTY : Ca#P...(i IQ1�K
OWNER MAILING ADDRESS: a. ' O-tm /d/ 42. /AO
ValtriatM4- /41
OWNER PROPERTY ADDRESS: s .l) '4Oy ',- , � = ► a
,:'/ ALI
TELEPHONE NUMBER OF CONTACT 'ERSON : 76 R 8q4:3
TAX MAP NO. : Section 1/.3 Block °7- Lot col
CROSS STREET : � ``
Jihil<
BUILDING PERMIT NUMBER CROSS REFERENCE:
Oar
44,7
► eat Ale:: :70
Signature of • aplican
RECEIVED BY : - WLR.
own Clerk's Office
DATE: ( o / � �
o.
Pb:� MIL L
iwaP„
P/
;I7 of , /
°well ✓/q s+ N
/J
C A4
— 41.20' ' , 0 cQ�f
N#S
O)
I 'sO°0• l vi 'R , At., D .
✓+ms' s e" 21 bs �. ./000 `w:::: tor-4.,0
c 1 SITE a IfLM2v,it ae. '3a r"qr / ` �;b M rry �i t( s.v' {a,eh•b tt.�` f'n �.C,f-C�FFiY �O b 4r/� `\ , Iia,7 G� Or -� lo+ 8 [
g LOCATION MAP Cc, Po , h r L,. ►o e°D tows
Z
-cep,..... ) ;or Vf N
�(/� tP
4, 5.--_. ,- /K8 fr-N of i /.,„„., , .l-
4t t� sys,L„ ta,, Ni�� Tes1 ABoring
Zp,' 4 °4e.y Q.\! Ur. Br. loom
S r� 01.
o� SI k atk G Q 1, / Hr, San}, loam
/. 7.3 C. 2' -------- --
C p 17,. Loamy Fon
6 �p01
tl SM
0 Polo Br. fine
\ • I�/eM e - to medium
�V PONT- Sand
A 7�. ��� 3. tp j__04/4-
SP
Ar•< '' T 0
ti r
`\ V- O Water In pole
-_ N .d br. Ike to
�\ -N\
N ,rre ,' Sand
t`.A y mss:. t -- — /3'
A }
J` \ 9`
e )% lW rz U `� o
�w_ , \ N.... ,..„:,,,,,,
� ie /in , N 0 aP. 1 ,v-- U
_y0j \ cp, Q�J/ along MNWµ Z t , �o.,
'5/ N\per, ,, ,,z . 0 �i" c /w
\ MP
ce i•
-----
OWNER* 4 �� N. 932500' W. A4.IAA I n
MICHAEL CLARK U
c/a TED MARTZ Q ° - _ 47.09' /_ .- Ow
145 RYERSON AVE. -__ --
MANORVILLE, N.Y. 1/949 r Ti, .a�+
K l vv
1-01•~`-4-- CREEK m 0 4
ELEVATIONS AND CONTOUR LINES ARE 3 J . A.,,,
REFERENCED TO N.G.V.Dalum. A o r..3.31 K 01
= PROPOSED CONTOUR r �iq• O.a�t •
V cee/e7i6 E Et V c0 x
FILL REQUIRED ZOO Cu. yds.
t, it'
1` "'ed.,�' U w O O Fn
Ai000 ZONE FROM ,y l /
C/A! ��_3 �e m i 51
.5c.“--,8/3 °//1-- E ��� I SURVEY OF d a fi
ate 4.,
LOT 5 A <
AREA - 22,838 sq.ft. to tie lines f�`°
JACKSON'S LANDING"
FiED MAR 28,1989 FILE NO 5280
The locations of wells and cesspools
AT MA TTITUCK
shown hereon are from field observations
and or from data obtained from others. TOWN OF SOUTHOLD
SUFFOLK COUNTY, NY.
1000- 113- 04 - O7
I am familiar with the STANDARDS FOR APPROVAL Scale: 1"= 30'
AND CONSTRUCTION OF SUBSURFACE SEWAGE Jan. 27,1997
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
Joy, 30 (511(...s/997 /SSET Fun. t DE
and will abide by the conditions set forth /herein and on the ) l
permit to construct. Feb Aon /9 f 7 .W.,).Afar. 25 /997 (20 e.(.e4.1e rewsrun)
j ' �r14, ��1997 (Jr,4 ser s.ti oaC)
19, , .A`.1".." V �MeY A5/1991(Aten.14p septia. Sys Per,, )
v,
ANY ALTERATION OR ADDITION TO THIS SLI4VEY IS A VIOLATION !
OF SECTION 7209 OF THE PEW YORK STATE EDUCA1I0N LAW All 4 1997 /
EXCEPT AS PER SECTION 7209-SUBDIV/SKIN 2. ALL CERTF7ICArTIONS
SAGO MAP OR CREON ARE ALID FOR OPrt S BEAR THE IMPRESSEO MAP AND D SEAL. THE SURVEYOR011',rah SeN 9 �/�
/�`/''gi�pp N.Y.S. LIC. NO. 496/8
WHOSE SIGNATURE APPEARS HEREON $Ui101k Co.C.Ofk+¢ a��l/11 X441 -_
:s 4,�r r-47I707 YOBS, P.C.
D 1*(711,1114911'MI Loan .) 6 � °
MUSTADDITUSED BY LLY TO ANY AM)ALLY WITH SSURVEYORAID LAW TS UTILIZWG A TERM ALTERED BY'
r• e_
OF ANOTHER SURVEYOR'S MAP. TERMS SUCH AS 'INSPECTED'AND `a set 1230 .7`RAVEt STREET
BROUGHT-TO-DATE'ARE NOT IN COMPLIANCE WITH TIE LAW. SOOTKOLp, .Y., 11971
n. cf