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HomeMy WebLinkAboutGoldsmith-Acosta, Cynthia SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4305-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner GOLDSMITH-AGOSTA, CYNTHIA Mailing Address 1 PO BOX 747 Mailing Address 2 City St Zip EAST MARION NY 11939-0000 Property Address 1 80 GUS DRIVE Property Address 2 City St Zip EAST MARION NY 11939-0000 Owner Telephone No. 631-477-2876 Tax Map No. section 38.00 block 7 lot 10.012 Cross Street SHIPYARD LANE Issue Date: 3/07/06 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) ,,,,,,,,,,,, -_, I, suFFoit ELIZABETH A.NEVILLE , Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 REGISTRAR OF VITAL STATISTICS : Southold,New York 11971 MARRIAGE OFFICER i. `� � Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER \- 1�`� Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER 1 �l"* 09,10 southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 or Non-Residential @$25 Application No. 131),� Permit No. 33/ I laAo /2 /�� 1aOwner Name C. �� i GL� DL�S1�1(,� O S T' Owner Mailing Address j30 7 4/ q Eas1- Ma.v N. ( 193 °' Owner Property Address DO QCk-5 7)rl lV C EC&s- - Ma r161 AI,V /19 3 °l Owner Telephone No. 103/ - Li q q. - . E-7--(.0 Tax Map No: Section 38•©O BlockOW T Lot let5AIL L!2 /0,O'2- Cross Street 3/ (/o a Iet fi Please check each that app es: New Construction k/ Alteration to ExiOng System Residential Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SCHD approval.) ,/ a .. 8* MA 1% .I 4 f. i ( .I •ture of Applicant Date I Received by: 1 III IIIIN 1 11111111111111g 11!„11 „.alt„IIILLIIIIIIIWILI J. AdialliiIiiiailaiiiiitailLa •„II„„„IL a u„i 11111.11111111N..1 -1.......,JIIIIIIN.111111-1.-- .1.._ .1.—1 LIAll.„ -Lill- , • . -11 SURVEY OF LOT 24 (,, ,,,,..._ i 0 i . . , MAP OF SUMMIT ESTATES, SEGTI • I N i e FILED MAY 21, 2002, FILE No. I01 I4up, • \. ci SITUATE: EAST MARION 1 • --,-. W ---''...rhAi....--- E TOIAIN: 50 L-B----- , .‘, ,. 4 c, .... z,. r_ ,,,,,, I I,:„...,,,i r .21.1...- SUFFOLK GOLIfffrINruNTY i-,..P A----- fs.: - ----- --' - - ---- moo! , ,,,'1- 01_, ----. , „., SURVEYED 12-2c4-20G14 PE E:n.1;7.31 PoTa t P7:21;.....a/A.L. -.1.7,-•,:-.KtD.,,,-,-,,.:1,7„,_.„,..„, , 000 1 0 r„rt.,” t_1..?, .,,,,,,,I,,,:c..,,,,s ,.....r.,:..E:y L.!....,LE z-T....,,rofet oivi.if -'e-- ! . •(.-) \c> 0 kie S 0P`j cS ,I-, rUFFO_LK3E3GO_UNTY_ 1 T.Al2/: :4 7-4-7A,' 71,/1,,i,-1.-,...- < , , "-'--,-‘.4,-, -,-,,,,,:% V r...P",' " 1 ,\\<A0( ro '0'-4i r),\P •'IV I I ......iiri . iii,r,,r.L,No. 0__,E.L.__2.;,____2_; _.... ...., r qJ le 9 API:R.017ED _ IT . #. -: :. . ,,-..-. eLkx:TAIFJ-. ,',1 OP - - Ab'EDROONIS .,..._ ,..,... ,.... ..... .cc\c" e- 1 Certified to: cc` Cynthia Goldsmith- 1,.: EXPIRES'IMRE YEARS FROMDATE OF APPROVAL ,\A• ll ( ci. c N., e ', o6 ...:, .<. / c \ VW alt z4 \<C,0-- <S\ Z -0 s.\ ''. -....'• /•,_ -1 1 t5cCb ,,7 __ . 0 0 Test Hole # 2 \ ,,,..40-- \ e '''es--' • 43 from Filed Mop 6,1, -6 I TOP SOIL 2.0 41.',_ c „ \ I 4, SANDY IV 9 LOAM ' ‹,". r, „..........,...... 4 • .k, z cuct, . , , .r--‘ .4p....‘ '7 , ----0 1 \ ---' , " e;.. V , .#„,. SAND 1 (*) ' \ tC Z AND is `,. &RAVEL itA \ z>:‘,. 3- e ! N.) o4 ) < 0 j4:..0T:tiEtOtf l:S" ' 17.0 L e0 0) if •3;":-7-4,,,•4'.;:t,:,.,,''.., -,,,, 9e ,. , NP. (fp('( , , 0:-.<-4 ,-,k'.''',,,, —Or ..rg=7.4v:—t7.---- LMT 010 lo-hpph 10 . . ;„,,,,i.",,':. .-: i• vblation of sectIon 7209,sub-divlslon 2.01 the .k.3).1 04)1) 't tt \ r'1 j- Ne.York State Educotbn Lars' NOTES: C.f. ...- rAO'$ c>c\\' • t. '''•:"..- 0- -- • th4 'Only copies from the orIgInol of this survey ''''v. • -_ if-D 5 -5,-.'"IitrbV9'OPZ="„7,7:2 \, ‹.- ,k...---'- .- -- , jA,i, .0e-• um MONUMENT FOUND •. , C)(j .Gertlfloollons Indlcated hereon skrtl thct thx. • C..:N 113t,aN; "t:',2,70 4e- .,"..72...r.rep,Titt7.:,-='.7..,:pto • eS , ... STAKE FOUND < N.3 1,- 0, ' . 141,• *Z ,,, ',.,, 1'71,4 ')('G;'-.. ,7 by the No,,York State Aissoolotbn si or Profesonal Land Surveyors Sold certifications shall run only (- ' / ij21, • to the person for nhan the survey is prepared Orid on his behalf to the title company governmen- tal aganui ond lencilng iretitution listed hereon,crici , ELEVA,T19N5 -wREF- 6n51.,JFFOLK COUNTY TOPO MAPS to thus ossIgnses of the Widely institution Cortlf Ica- Wm)coo not trarof croaks to additional institutions ile , • ' AREAlird 50,157:5F,OR 0.61 AGRE5 _ JOHNC. EHLERS LAND SURVEYOR _ . — ....;----------6.4i-10401--'7143H-, ., -__i. .. ,,,,,•3•01.::3,6---G- , ....„4 ,,• , -,-__.:...,—,....0 5., 5_, _...5. ,. ... .......................,-*,'"...........m......,........-4,....,410,.....,,*.nm.*...r -,.......,........w....M.,..........+.*...,.1.0,,...x..-. ,....`,....- ....,,,, ... GRAPHIC, 1"= 30' Z Tf 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 5GALEL:),:i <.) 0- . 1 : 6111Will6WIIMMM . 61 'z' RIVERHEAD,N.Y. 119.01369-8288 Fax 369-8287 REF.-\\Hp server\d\PROS\04--349.pro ... T......' ...... 1010•m ......•"''.''' • , , • • .. • 7., I