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HomeMy WebLinkAboutCsicsak, Eugene • • % •o _ • V . �,•� Town Hall, 53095 Main Road %, P.O. Box 1179 •_( I . Southold, New York 11971 JUDITH T. TERRY �"����"1111 TELEPHONE TOWN CLERK (516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD October 13, 1987 Eugene A. Csicsak Box 429 Mattituck, New York 11952 • Re: 18500 Main Road Mattituck, New York Enclosed herewith is the Construction, Alteration or Modification Permit for a Septic Tank or Cesspool System for which you applied. Please be advised that each owner of real property operating an on-site sewage disposal system, such as a septic tank or cesspool must, prior to such operation, possess in the name of the owner an Operation Permit for the system. The Operation Permit is issued by the Town Clerk's Office. The fee for an Operation Permit is ten dollars ($10.00) for residential use and twenty-five dollars ($25.00) for non-residential. Please have the owner complete the enclosed Application for an Operation Permit and return it to this office along withthe proper fee. For your general information I have enclosed an Informational Bulletin regarding the Scavenger Waste Laws adopted by the Southold Town Board. Should you have any questions pertaining to either permits or the Scavenger Waste Laws, please do not hesitate to contact -this office. We will be glad to assist you in any way possible. Very truly yours, Ogoll • Judith T. Terry Southold Town Clerk Enclosures (3) JTT/Ijc • OFFICE OF THE TOWN CLERK S�FFOC��," Town of Southold flj Judith T. Terry, Town Clerk L' Town Hall, 53095 Main Road P. 0. Box 1179 Southold, New York 11971 :y� Telephone Ali (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 233 Residential • X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: NAME: Eugene A. Csicsak ADDRESS: Box 429 Mattituck, New York 11952 DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION New Single Family Dwelling with Cesspool System APPROVED as per Suffolk County Health Department approval. LOCATION OF PROPOSED CONSTRUCTION -or ALTERATION: OWNER OF PROPERTY: Eugene A. Csicsak OWNER MAILING ADDRESS: Box 429 Mattituck, New York 11952 OWNER PROPERTY ADDRESS : 18500 Main Road Mattituck, New York TAX MAP NO. : Section 115 BIoOk 6 .. Lot 2 CROSS STREET: Cardinal Drive BUILDING PERMIT NUMBER CROSS REFERENCE: • Judith T. ferry Southold Town Clerk DATE : October 13, 1987 (TOWN SEAL) „eeiiii „,,� UFF ir” + � 'Town Ball, 53095 Main (toad : e1P.O. Box 728 �'� �;d to 1Southold, New York 11971 11'1)1111 "1 1 I IZIZY 11'1.1 P11ON1. l U vy ('i i p r, (516) 765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD October 8, 1987 To: Victor Lessard, Southold Town Building Department From: Judith T. Terry, Southold Town Clerk Transrriitted herewith is a copy of application No. 238 for a • CONSTRUCTION or ALTERATION Permit for a cesspool or septic system submitted by Eugene A. Csicsak Please review the application and location map and advise if the project has received Suffolk County Health Department approval and if we may issue the permit. Please complete the form below and return it to my office. Thank you. efe e$0411 Judith T. Terry Southold Town Clerk * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendation: APPROVE - )C DISAPPROVE - COMMENTS: 01,0 sg .. 1 @t . 4 ti9t Nr. c3L A c.iifrk-4..) at44,.$1. Signature Date V.,' OFFICE OF THE TOWN CLERKc0FOL- JudithTown of Southold Town Clerk ' ' Application No. 02o'f Terry, Town Hall, 53095 Main Road Construction P. O. Box 1179 $ Alteration Southold, New York 11971 f°l [ �.a� � Residential --- Telephone(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 $ /0 DATE /U - - 87 APPLICANT NAME: Eve, t' A, o s l C SisK APPLICANT ADDRESS: 80‘ -- SEPTIC -SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION New wf1 4 /►r1 i y Dc N we, LOCATION MAP: Must be attached hereto before permit may be issued. • LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: CQ4Z&Zvi 4, e +c$,att OWNER MAILING ADDRESS: ,(3c '47-9 0 - v T-ravcV- N•P 1�g5Z OWNER PROPERTY ADDRESS: /8 Sc}o MAIN Qe,a0 • /ti•11-1.1.T-vc . 1a.SZ TELEPHONE NUMBER OF CONTACT PERSON: agg <!=jC78 TAX MAP NO. : Section //S Block G Lot Z CROSS STREET: CA40 t^rAl-- Oe We_ BUILDING PERMIT NUMBER CROSS REFERENCE: a co,..c_,a Si nature of Applicant RECEIVED BY6744_1(„6„... Town Ierk's O� ffice DATE: ,� /; /7 • toJUN 12 4.9.,:,- . 9.,„ I\ ,, +C SL _ EC h FL= '' T ►�' ' (N.'S. 1E•25' 6- mgAIN( SR®�� (64/ �nA-( HELL �` 100.00 0 •N.88°08'20"E. IJ 88°18 20 E. EL=38.8 80.00 ( EL_37.8,J ,� •�„eI ��`SOO BUIL SETBACK UNE ISS _ -- ------- TFE D —`_" cn 'Xz C7NNNNN, — D �_ _© d . DWELLING •4 \ • ', D7 16, t-, CPO (VACANT) 10'(' 9 Lot 3 i' Lot4 r` ISA Area 20,000 s.f• f NN Ir O I: I i [- rr E L-33.8 1 EL=33.9 N",--____ S.88°08'20��W. 100.00 Lot 6 Lot 10 Lot II (RESIDENCE (RESIDENCE 100+) 100•) j , 1 ['DWELLING •- • t N f •*N * SURVEY FOR EXPI • ES TWO YEARS FROM DATE•OF APPRO kit,GENE A. CSICSAK )UFFOI_K COUNTY DEPARTMENT OF HEALTH SERVICE! LOT NO.4 " MATTITUCK ESTATES,INC u • "I AT MATTITUCK DATE: JUNE 3,1987 TOWN OF SOUTHOLD SCALE: I":30' T' .__ \ -7--'36 _ -SC ) -0 7 SUFFOLK COUNTY, NEW YORK NO. 87-0883 ( .7. R UNAUTHORIZED ALTERATION OR ADDITION TO THIS GUARANTEED TO: I. _ SURVEY B A VIOLATION OF SECTION 7209 OF THE IETRURSI;�9ROV�';' NEM YORK STATE EDUCATION LAw EUGENE A.CSICS" N COPIES OF THIS SURVEY NOT SEARWG THE LANA TITLEUSA INSURAOF NEWYORK--^ SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL�9 (telj NOT BE CONSIDERED TO RE A VALID TRUE COPYNOTH FORK 6ANK COMPANY ( (— N GUARANTEES INDICATED HEREON SHALL RUN ONLY TO HEALTH DEPARTMENT-DATA FOR-A L TO CCC"STPUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN- O NEAREST WATER RAIN ML_+ S N SOURCE OF WATER PRIv<TE-IPuiRLic_ MENTAL AGENCY AND LENDING INSTITUTION LISTED '. j R BUFF CO. TAX MAP DIST TV00 SECTION !IBLOCK 05_ LOT 0Z_ HEREON,AND TO THE ASSIGNEES OF THE LENDING -;--, f *THERE ARE NO DWELLIM4f WITHIN 100 FEET Of THUD Apof•EPTY INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE I OTHER THAN THOSE SHOWN HEREON, TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT R THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTF_M FOR THIS RCA I()CHM OWNERS �\ ;,c. A WILL CONFORM TO THE STANDA POI OF THE SUFFOLK COUNTY DFPARTwF.NT R DIST ANCES SHOWN HEREON FROM PROPERTY LINES Th/� , TO Ex!STING STRUCTURES ARE FOR A SPECIFIC OF HEALTH ACAVICE 7. PURPOSE AND APE NOT TO RE USED TO ESTABLISH ,,r ATUCANT PROPERTY LINES OR FOR THE ERECTION OF FENCES S:'•. ADOPE!S j [� f^► ^' 400 OSTRANDE R AVENUE TEL. �` YOUNG' YOUNG RIVERHEAD, NEW YORK N^TE : Pi- MONUMENT 24 a i* ALDEN W.YOUNG,PROFESSIONAL ENGINEER 44. SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF w` i'�, 44 AND LAND SURVEYOR N.Y.S.UCENSE NO.12845 SUFFOLK COUNTY ON SEP. 8,1955 AS FILE NO. 4453 ': HOWARD W.YOUNG, LAND SURVEYOR *114E LOCATION OF WELL(w),SEPTIC TANK(ST)S CE5 QOLS(7)sWowN HCR�ON - N.Y.S. LICENSE NO.45893 At ARE FRMA.FlELD RWWt1T10N3 ANO OR DATA ner�uN�Ffi�e.Ncwe --.,,_ -- - —