HomeMy WebLinkAboutMartz, Theodore ff'�gUF i;
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JUDITH T.TERRY ��_ O'L� Town Hall, 53095 Main Road
TOWN CLERK y - P.O. Box 1179
11- r �� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS `0 �1� Fax(516) 765-1823
MARRIAGE OFFICER p y1
RECORDS MANAGEMENT OFFICER --- I , `1:
, Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1698 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. #R10-96-0114
Name Of Owner MARTZ, THEODORE C. JR.
Mailing Address 1 145 RYERSON AVENUE
City St Zip MANORVILLE NY 11949
Property Address 1 65 ROSEWOOD DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 113.00 block 2 lot 15.000
Cross Street COX NECK LANE
Building Permit Number Cross Reference:
Issue Date: 7/08/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY , = Z� Town Hall, 53095 Main Road
TOWN CLERK ; y P.O. Box 1179
A7 � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O 1
MARRIAGE OFFICER `y O�111 Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER =�0,( Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER -.0
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 2, 1997
Transmitted herewith is a copy of application No.
Septic Tank Construction Permit submitted by: 1768 for aCesspool/
Theodore C. Martz Jr.
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.
�jcdceJ
Linda J. Cooper
* * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments:
,Signature
Dated
p
OFFICE OF THE TOWN CLERK c0FU01-„” _
Town of Southold * CDS Application No. M.(
Judith T. Terry, Town Clerk •l' :
Town Hall, 53095 Main Road �, 4•.'eA. Construction f
P. 0. Box 1179 � J Alteration
Southold, New York 11971 O' 0-.°
f-"Telephone of 4t • 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 .$
DATE 6A/9_,,,,
APPLICANT NAME: / 4130dezci } / 70e'
Aex,se--4).
APPLICANT ADDRESS:
ON dle 1 A. 4, 49Y-7
SEPTIC CESSPOOL
DESCRIP ION OF PROPOSED CONSTRUCTION OR ALTERATION
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.. c7tt..,...e.z&l
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED C UUCT ON OR E TI
OWNER OF PROPERTY: ✓ -PC
OWNER MAILING ADDRESS: AL i :' - c"''`T
./ o/`/e , f/Q�- '
� y
OWNER PROPERTY ADDRESS: 4
yi&se&zadl
:/' , ,c //qS2—
TELEPHONE NUMBER OF CONTACT PE •g2r lg. )LH-
TAX
H-TAX MAP NO. : Section //8 Block °Z' Lot /-S----
CROSS STREET:_ ) ,cy,,(�
BUILDING PERMIT NUMBER CROSS REFERENCE:
. ea70
Signature of • pplic,
RECEIVED BY : d_
Town Clerk's Office
•
DATE:
•
is fes S G pc .s p w p,a
w/,A.n /50- .
•
Si I SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
ROSEWOOD D R I V E MEW'FOR APPROVAL of CO? TRUCFION FOR A
SINGLE FAMILY RESIDSN ONLY
/�b -� DATE i '%`!9. , ' K$F��[Q, )D- 5 • D tL
S. 9675'00'E. ..:, - i,
/46.62' 4 ° APPROVED' 1•,.. . 4•..1--1,
rI a FOR MAXIMUM OF i' BEDROOMS
0 I F Sm., °
I
/Drop G 5 9 S` EXPIRES THREE YEARS FROM DATE OF APPROVAL
C G P 1 o L p ysrc.,, w r
_ N 5O 85s R` `.0*, (�, p3 ��N EWE ROM
40• %�+�95 cn O
.r Prop 'Lr . "'�' X SURVEY OF
/7 5e a
,, ch
,,en.„), LOT 4
0-
o • "ROSEWOOD ESTATES"
m Z FLED JAN 24,1988 MAP NO.5240
m AT MA TTITUCK
W I -,Z-
'
(.) TOWN OF SOUTHOLD
P �,
N. Y.
a , 7� SUFFOLK COUNTY,
1000 - 113- 02- 15
LOT 0 ; Scale: 1"= 30'
' __5 '"°
LOT
D Dec. 4, 1996
25 4
189.04' Z
well
S. 85'09'20' W.
v
aca b
o
b_� LOT 0 r-- � ° o
LOT ` i s/TETI ',":77.-TLY AND SEWAGE DISPOSAL SYSTEMS MUST
C)Y 3n"r:Vc,TrE N W STANDARDS DATED NOVEMBER 13,1995.
AREA = 20,470sq.ft !- --
The loco/ions of wells and cesspools � I <44
shown hereon ore from field observations
and or from doto obtained from others.
�$�Et NEJE `' 195
I am familiar with the STANDARDS FOR APPROVAL S �K t•47j Q -; ;t)Serie'
AND CONSTRUCTION OF SUBSURFACE SEWAGE ", s °Q. . _ P'sate-01M
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES a .- -
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LA W and will abide bythe conditions set forth therein and on the 7" yy e- NO 496/9
EXCEPT AS PER SEC 770N 7209-SUBDIVISION 2.ALL CERTIFICATIMIS i 5, S. C7
HEREON ARE VALID FOR THIS MAP AAO COPES THEREOF ONLY F permit to construct. ,---Am/ l�/z i
SAID MAP OR COPES BEAR THE IMPRESSED SEAL OF THE SURVEYOR PECON '77'7 P.,
WHOSE SIGNATURE APPEARS HEREON. (516) 7 zGu 0496' .
ADDITIONALLY TO COMPLY WITH SAIDLAW THE TERM ALTERED BY' P• 0. BO x J�
MUST BE USED BY ANY AND ALL SURVEYORS UTLI2WIG A COPY ELEVA TIONS ARE REFERENCED /230 TRA M P 1• T
OF ANOTHER SURVEYOR'S MAP. TERMS SUCH AS •tISPECTED'AAD TO AN ASSUMED DA TUM. SOUTHOLD, `. . •71
BROUGHT-TO-DATE'ARE NOT II COMPLIANCE WITH THE LAW.
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