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ELIZABETH A.NEVILLE /...-za O . Town Hall, 53095 Main Road
TOWN CLERK 41 * , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS G � Southold, New York 11971
MARRIAGE OFFICER �1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER l�'C `` � Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ��� southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3457 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JULIANA ZINGER-ROBERTSON
Address 1: 1660 INDIAN NECK LANE
City St Zip PECONIC NY 11958
Descripton of Proposed Construction or Alteration
-EXSPANSION OF ATTIC & SEPTIC SYSTEM
-FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT
Name Of Owner CHRISTIAN ROBERTSON
Mailing Address 1 1660 INDIAN NECK LANE
City St Zip PECONIC NY 11958
Property Address 1 SAME AS ABOVE
City St Zip 0000
Tax Map No. section 86.00 block 4 lot 6.100
Cross Street RT.25 & LESLIE LANE
Building Permit Number Cross Reference:
Issue Date: 7/19/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
,•%OGS0 '•
ELIZABETH A.NEVILLE �c l0 : Town Hall, 53095 Main Road
TOWN CLERK 4 4 t P.O. Box 1179
vs Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS ;
MARRIAGE OFFICER �O �/ Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER N. l ��� Telephone (631) 765-1800
FREE 1 M 9F-INFORMATION OFFICER =�COUn COW( southoldtown.northfork.net
i
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 3612 for a Cesspool/Septic Tank Construction or
Alteration Permit submitted by:
Jolina Zinger
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 V
DISAPPROVE
Comments: ,77e�� 4" 2
Signature
07A--/04
Dated
i
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,,,��o�os�FFoL4.�o, `
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ELIZABETH A.NEVILLE ,,e I,y�t ,`
Town Hall, 63096 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 1i Southold, New York 11971
: G
MARRIAGE OFFICER '�,1t Fax(631) 765-6145
RECORDS MANAGEMENT OFFICERy�fe ����i1 Telephone (631)765-1800
FREEDOM OF INFORMATION OFFICER = '� 4I `t' southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT •
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10or Non-Residential @$25 Applicati No. 'Avel•
Permit Na. 3_,I --)
Applicant Name "� ► rOL i'�, — g.g e,i S' i-
Applicant Mailing Addre� 1 66 6 4 )(k-v1G et)
Septic Tank or Cesspool _p f
Brief Description of Proposed Construction orrAlteration bua ,r� .----,04 ciSt` C
4 ta.,,,,r;i;il P jcz.tAAAri
Location of Propos nstruction/Alteration:
Owner of Property: C. k n S V1 c2.v1 /2,6 c>,vA 0 in
Owner Mailing Address: o O -4/ed4 L ,,
Owner Property Address: S "-
Name and phone number of contact person-Tv)I OUh9`, 3;IRA • gl 64,61 i1t 41-s- I
Tax Map No:i?3Y Section 0E‘0 Block CO() (/ _ Lot 006 .0f)
Cross Street n /0L— I t !r) k k 2s i-A.A /,'C 14,
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
,o • % . i 4 2- 2 -4-
4.ture . 'Applicant D:to
Received by: (fa
i, \ �E� �, LOT 1
MAJOR SUBDIVISION MAP OF
• :• t n
WILD OATS
�' ,,� ,.Et 9331 FILED MARCH 9, 1993
a
' � . • ITUATED AT
tri �..,, AN'•''• • • I 45.7 N.- Z +'r
1''1 \" •.a ` `,;, J��N2� '-',.. PECONIC
' 1PW► . OF SOUTHOLD
�'. • d ♦ 48.8 ~ � � �,,,..:. ^�nT.
\ / LK COUNTY, NEW YORK
��$"5 \ • , /A
S.C. TAX No. 1000-86-04-6.1
2 �o 1 \ SCALE 1"=20'
O .d •`� FEBRUARY 7, 1996
\ O,, • \�/ OCTOBER 30, 1997 FINAL SURVEY
\0. ° �• \--/), ` JUNE 28, 2001 ADDED WOOD DECK
< APRIL 24, 2006 ADDED PROPOSED SANITARY SYSTEM UPGRADE
t� e 4 4 Z AREA = 39,999.76 sq. ft.
\ 0.918 ac.
,4. a
\ 41\ 0-( SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
4 11
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
• ° 01� &INGLE FAMILY RESIDENCE ONLY
- \ •
Tpo DATE6?- 1-OGHS REF NO. R a ,
y
APPROVED
14*Std 0 \ °. , FOR MAX 4UM OF' . BEDR S
d• EXPIRES THREE`BARS FROM DATE OF APPROVAL
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/ 0 8' DIA, 8' DEEP CESSPOOL •
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0 CCSLING 8' DIA, '
6' DEEP CESSPOOL PROPOSED 50% FUTURE 6'J • C�
EXPANSION POOLS
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6' DEEP LEACHING POOL 4 • ------- �2 ° ° • d
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° n SO�E•00 P° . <" 49.0. 1' ••
• • NDS /� I0 •8 rq.a, UNATHORIZED ALTERATION OR ADDITION
P� y �' . ° • TO THIS SURVEY IS A VIOLATION OF
4 • �• ,-A'S Y 4 • , `2.� d SECTION 7209 OF THE NEW YORK STATE
• • EDUCATION LAW.
•• ° Y d
4 ° 4 44 13N d e 7T ° °a COPIES OF THIS SURVEY MAP NOT BEARING
�S • a THE LAND SURVEYOR'S INKED SEAL OR
SR Q p, EMBOSSED SEAL SHALL NOT BE CONSIDERED
4 TO BE A VALID TRUE COPY. ,
------
�� • • CERTIFICATIONS INDICATED HEREON SHALL RUN
•. ONLY TO THE PERSON FOR WHOM THE SURVEY
i SE1fAF � • IS PREPARED, AND ON HIS BEHALF TO THE
s TITLE COMPANY, GOVERNMENTAL AGENCY AND
// • /10 E a d' •` d LENDING INSTITUTION USTED HEREON, AND ;1:
�/ % 11�sfg IT • TO THE ASSIGNEES OF THE LENDING INSTI—
.iDN °o P. /'.� t O r3 TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE
. DE 00 a, off. Y ��
5 4 ScO '‘.3` THE EXISTENCE OF RIGHTS OF WAY 1•
Z S AND/OR EASEMENTS OF RECORD, IF
d
`•; ANY, NOT SHOWN ARE NOT GUARANTEED.
.../ ¢"�d�
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• - PREPARED IN ACCORDANCE WITH THE MINIMUM
- ° cam$' —!....u,
STANDARDS FOR TITLE SURVEYS AS ESTABUSHE
it BY THE L.I.A.L.S. AND.APPROVED AND ADOPTED
FOR SUCH USE BY THE NEW YORK STATE LANI
A,�/ N TITLE ASSOC ON.
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N -t N.Y.S. Lic. No. 49E
•
TATIONS ARE REFERENCED TO AN ASSUMED DATUM fig r '
:XISTING ELEVATIONS ARE SHOWN THUS: 10.0 Jac fA 1vim.
:R TO FILED MAP FOR TEST HOLE DATA. Jose -n d . Ingegno
LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON .�
FROM FIELD OBSERVATIONS AND/OR DATA OBTAINED FROM OTHERS. O Lend . urveyor
/IOUS S.C.D.H.S. REFERENCE No. R10-96-0030.
TING SEPTIC TANK TO BE PUMPED CLEAN AND EITHER REMOVED
' FILLED WITH CLEAN SAND AS PER S.C.D.H.S. SPECIFICATIONFZ e d ,,* Title Surveys — Subdivisions — Site Plans — Construction Lays
'U 01 f PHONE (631)727-2090 Fox (631)727,1727
�'J• �.0. I1d3H OFFICES LOCAILU AT MAILING ADDRESS
A1. nil"' 3 033f S 1380 ROANOKE AVENUE P.O. Box 1931
I ' 130 RIVERHEAD, New York 11901 Riverhead, New York 11901
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