HomeMy WebLinkAboutAcker, Anna (2) •
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ELIZABETH A.NEVILLE 1e '`� l0 `y Town Hall, 53095 Main Road
TOWN CLERK i P.O. Box 1179
S' Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS G
MARRIAGE OFFICER ; '�l . ' Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER i� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER =�°OUWT1,* °. southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4316-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner ACKER, ANNA
Mailing Address 1 PO BOX 429
Mailing Address 2
City St Zip SHOREHAM NY 11786-0000
Property Address 1 855 PINE NECK ROAD
Property Address 2
City St Zip SOUTHOLD NY 11971-0000
Owner Telephone No. 516-818-7103
Tax Map No. section 70.00 block 5 lot 33.000
Cross Street MAIN BAYVIEW ROAD
Issue Date: 8/03/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ~� \` Town Hall, 53095 Main Road
TOWN CLERK ; _ P.O.Box 1179
REGISTRAR OF VITAL STATISTICS ��O'y . �� Southold,New York 11971
MARRIAGE OFFICER Op / Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = l * `ft,O. Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER ..,,,,.�� 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. 3
Permit No.
Owner Name A htivxA _k exam-.
Owner Mailing Address P` a o x 9
Sh�Yel.�a w• rl t '7 Ft
Owner Property Address S S F) ;rte f 1 e c c
So tot L ny ((x'11
Owner Telephone No. 14'S '7(03 c Q .P
Tax Map No: Section /0 00 Block 7 a'0S Lot 3 3
Cross Street fi a 8 v ei
Please check each that applies: New Construction
Alteration to Existing System
Residential t 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 cry of surve with SCHD approval.)
c 7 �8/0 6
Signature of Applicant Date
•
Received by:
SCDHS. Ref. # RIO-04•-0072
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION
OF SECTION 7209 OF TIE NEW YORK STATE EDUCATION LAW,
EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS r. ,
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY /F SU Fay.0�''�,.,,,,,: i f "1 <, ": .+T O'- EA!T SERviCE
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR � � `h r C _ T
WHOSE SIGNATURE APPEARS HEREON. +a,., E�.• ¢C:, =��
ADDITIONALLY TO COMPLY WITH SAID LAW THE TERM 'ALTERED BY' If., w+ r F e r
MUST BE USED BY ANY AND ALL SURVEYORS UTILIZING A COPY ^ q ��� 'r f: ., O —��2
OF ANOTHER SURVEYOR'S MAP. TERMS SUCH AS 'INSPECTED'AND —y--�..
'BROUGHT-TO-DATE'ARE NOT IN COMPLIANCE WITH THE LAW. ;-.c;r>F L`„ , t ',r �, as ,S
4 :on SdtP A 1 c•",'-,--,:- ; :AREA = 12017 ac ., �� ; ,, s an have
.W. E.Cor @. l A fl - r- 4G�1/1J.
The locations of wells and cesspools .F s.,,. ,
shown hereon are from field observations Er,,a,, .r. 5 ", 'i .,,7 , j
and or from data obtained from others. �/O C�( rr:X31 p t f . - �eM •ac,ement
I,
I am lamilor with the STANDARDS FOR APPROVAL \ �y �`�
AND CONSTRUCTION OF SUBSURFACE SEWAGE ClipDISPOSAL SYSTEMS FOR SINGLE FAMI!Y RESIDENCES
and wi abide by the conditions set forth therein and on the .s63�
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permit to construct. p \ SS w
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1 �4 �,'. vi) �, `�. -•+;(1_ CERTIFIED TO•
e c F —, `- e ANNA ACKER
,e, ? ' . \ �w , ABSOLUTE ABSTRACT, INC.
712):444.6.6..--"I
eb' Sr�14E FIDELITY NATIONAL TITLE INSURANCE
�'t!ti s$f f '� COMPANY OF NEW YORK
iivoRaf."0:;114:: :::0.5:9,:.1:4:6i:/::":''''''''Sir0:11''''
ot NI �,sP`- °� WARer SEPTIC SYSTEM MEASUREMENTS
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'`� LP.#1 102' 69'
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v>\, . .0 Q L P#2 85' 81.5' {
I1 ST#I 12.5' 18.5'
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,, SURVEY OF PROPER T Y
AT SOUTHOLD
°� ° TOWN OF SOUTHOLD
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• SUFFOLK COUNTY, N. Y.
e 1000 - 70 05 - 33
SCALE: 1" - 50'
Q ' 4 i 3 OCT 1, 1998
^r 6 'i.r3 MU L 24600/999 (contour lines )
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.2M DEQ". 15,20C'.' RES.=R SET)
Q co Jan. i 3, 2004 (certifications added)
me Z O APRIL 18, 2 (foundation)
- e�y= O 374,N, 3 2006 (rk'oP. GAFe )
��cu FEB. 2�, 2006(FINAL)
441. •
3 l' Jane 2004 (re , - •
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145pQ+ Iy
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/33.97
5o�a;MET_CI�
JUN 2 o 2006 NECK ROAD * �� ,� {'��t,
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By 7 —r r • 1— .� 0. 4.618
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`ECONIC SURV Arli-,g961'
D.W. - Drywell WWI 765 - 502• �•,, ..NDS
CONTOUR LINES ARE REFERENCED TO N.G.V.D. P. O. BOX 9E
1230 TRAVELER
ER SIRE
SOUTHOLD, N.Y. 1197/
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