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HomeMy WebLinkAboutBancroft, Martin Jr i %S)FFOL,# �' O t ELIZABETH A.NEVILLEti,�� Town Hall, 53095 Main Road TOWN CLERK o - P.O. Box 1179 REGISTRAR OF VITAL STATISTICS " ,i Southold, New York 11971 MARRIAGE OFFICER :` y l��� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER �_'*Ql -0„.rig Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER ��� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4196-R Residential X Non-Residential Fee $ 10.00 New X Existing Name of Owner BANCROFT JR, MARTIN Mailing Address 1 PO BOX 483 Mailing Address 2 City St Zip ORIENT NY 11957-0000 Property Address 1 38099 MAIN ROAD Property Address 2 City St Zip ORIENT NY 11957-0000 owner Telephone No. 631-584-5454 Tax Map No. section 15.00 block 2 lot 16.000 Cross Street GREENWAY EAST Issue Date: 4/10/03 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) s OFFCE OF THE TOWN CLERK O �F FO (,, TOWN OF SOUTHOLD ��� �c,G Application No. /�'` ELIZABETH A.NEVII.I.F,TOWN CLERKlf. $10.00 - Residential P.O.BOX 1179 tri SOUTHOLD,NEW YORK 11971 *.$ $25.00 - Non-Residential Off';' Telephone '4o.( ,i ) �' (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICAT ION for OPERAT ION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ DATE t' 1-10 3 OWNER NAME: 111/11� . ' a ►, 0 A. OWNER MAILING ADDRESS: f.O_ Eox ki- .3 CD LE wi---) ) .Y., k. I. cl 5 4 OWNER PROPERTY ADDRESS: 310:15k Ivli 1-D OWNER TELEPHONE NUMBER: �2ft ' ' S x `O3 TAX MAP NO. : Section k 5 Block 9..._ Lot CROSS STREET: Ga,:. W i, 1. TYPE OF SYSTEM: Septic Tank New Existing Cesspool New Existing Residential ✓r Non-Residential LOCATION MAP: Must be attached hereto before permit may be issued. (Locate building and system; give north arrow and feet of distance, approximately, to building and closest road.) / 1 , ,...10, ......_ ....4„/ / ieJ,4 r.drill 1 6.0 4 4 AiAl fali 0' ' 'd 'O.'- /*'tee .f App/r'an RECEIVED BY: Town Clerk's Office DATE: ... ---- _ _ _ _ _ , . : . SURVEY OF PROPERTY AT O ., , TOWN OF SOUTHOLD � S UFFOLK COUNTY N. Y. ii0„, \ t1T rye 1�-1S-0z 16 1 SOUND SCALE: 1~ 40' FEB. 17. 1999 ter- ' — -____ FEB. 23, 1999 l revision t APRIL 26, 1999 ( revision 1 S 81' 8' 1 -� MAY 19, 2000 ( certification) E 101, M.H• SEPT. 9, 2002 l conc. foundation 1 Z 58 U)- W.M FEB. 5, 2003 ( final I Feb /1 2003 (rev's/aO O O N N d at 11. 0 7Z----- S1=8.3• * E1,-7.5' aettalli of 111410., haft of t . of boa t\ LIF 23.8' a.25.a'A 101.4e Z 407c Pil 03.w 0 CERTF1ED TO' MARTIN J. BANCROFT, JR. � � C � 'AINY OF WW !'CSAl40eraiN TITLE C�31E� E -, `; �'� ,, Ian+ fad► with the STA ARDS FOR ANAL tiA AM) CONSTRUCTION OF SUBSURFACE SE1Mat ° roQan DISPOSAL SYSTEMS FOR SINGLE FAY ,RESIDENCES and wwY abide by the conditions set forth *wain and on the T SCOTT v1permit to construct. . CE i sty: CMFRV CM v a 25.4' a,.4_ _ -_ The locations of wells and cesspools 'i , -- shown hereon are from field observations \ f and or from data obtained from others. Ns ‘ _ rwaro ms% i AErsi t f EJ EL.2B.6 s 0 L (o- - V>G '' * EL. 24.5 01 87153'30" q 1 •� t OZANY Ni©/F R Pi) .I iacant) 0• kot i $^ 9. a "' — — —i• Brown clayey loam OL ,43 29,546. � . I - - — • Brown loamy clay CL AREAt to tieline 1 ,., s Brown clayey sand with heavy gravel SC • = E 1 1 • MONUMENT %6l (Sit. - - -14' • Brown line to costae rand EAN SEA LEVEL TO 20• ac, .../ •, ro_siv) Hozo-e Liil e r�� TEST HOLE4 0 NEW 5u �,.1' 1 Erje 04, ,Aoto !f .fi -� ' J i-ft ,ti� ' ;/:31 N. Y.S. LIC. NO. 49618 ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLA TION i�+i �..' '� ��} "EC�i!' ;'•UR I►RS• P.C. �,,, f . - F�., ,,. - a 0 FAX (631.1 765 - /797 tit , 6 OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. r EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS \L '1� n'�Z l''' . (4 : a •�::• HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF .. n ' I i k � u• �.� 199-- 125 ,�� �':� 1 - �► ' - ; STREET SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR i r ;r {sq1 WHOSE SIGNATURE APPEARS HEREON. t 1 •:'D :_ a■tai 0 N. Y. 119 71 ` ' its