HomeMy WebLinkAboutMartz, Theodore Jr (3) '
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ELIZABETH A. NEVILLE 4
� Town Hall, 53095 Main Road
TOWN CLERK t * P.O. Box 1179
Southold,
REGISTRAR OF VITAL STATISTICS G Q c
New York 11971
MARRIAGE OFFICER -14),, -kb1, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER `._ i`C ^a,'l�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER AUNTY+ ��� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4343-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner THEODORE C MARTZ JR.
Mailing Address 1 145 RYERSON AVE
Mailing Address 2
City St Zip MANORVILLE NY 11949-0000
Property Address 1 275 WEST COVE RD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 631-878-8443
Tax Map No. section 111.00 block 3 lot 400
Cross Street HAYWATER ROAD
Issue Date: 6/29/07 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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,��,���g11FF0��-c;V. ELIZABETH A.NEVILLE ����`t`� Town Hall, 53095 Main Road
TOWN CLERK ; p I • - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS eA f
Southold, New York 11971
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MARRIAGE OFFICER : 1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER '.. a��'/ 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. 31/
Permit No. 3111 i
-.6Owner Name l 1 •ot.C� 0 ..iR `
Owner Mailing ``Address hW
I . i11-4.1
Owner Property Address .: 1 IANezzr LI
3ii2i1
Owner Telephone No.
/At ^ BAB - 8 3
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Tax Map No: Section I`\ Bloc Lot
Cross Street e k4)4
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Please check each that applies: New Construction
Alteration to Exist' ystem
Residential Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate di ance in feet IA m system to building
and closest road. New construction may submit copy of s. ey with SC, . a proval.)
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Signature of Applicant '' Date
1
Received AA i. _Pi
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BLOCK: 3 LOT(S): 4
R10-07-0062
LOT 12 c
ROAD EL 59.1 Selo, 7
RAYWATER291.85 �'°`�' a.20, \
LGI 15 41 ,
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9006"6*
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Com' M .)0,
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68oQ4'`�Q»� rn 0- N LOT 16 `19�5
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IV p 516,0 p0
O 'Ab .7 N 44 Fit.
00 . • w 196.09 SNEO 1
S�pN� t` 60 $° ^;��ti w f. 31.E N `3A` SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
5.0 sA �' 4� 5 11`5 k4APPROVAL OF CONSTRUCTED WORKS FOR
0 8�� . w z6'zs sTNcc LOT 17 � A SINGLE FAMILY RESIDENCE
'J' ° %b 17�43 ` �� 5 Data JUN 15 H.S.Ref.No.
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• 33' 34' �o :• s+ The sewage disposal and water supply facilities at this Ic»r�tien have been
6� ed stone
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In andfor certified this rL P
w(q‘2 0. 36-6E 152'''
y� /' sEr °M1O�' bespeerd FORby Oepa me or other agencies and fou
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,A1.y3• “" satisfactoryA MAXIMUM . BEDROOMS. ,�%V
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1006 ,;,•p
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N 1 Walter J.Hilbert, . r cw
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11' 0• /
0 foot ws le Office of Wastewater Management CP' yJ'
`' 604 w 3315,0.0
2 ,,� Q REVISE SANITARY 'LOCATION 6-6-07 OW
Q;A0 M 1 VS FINAL SURVEY 4-17-07
ti 3"1Q FND. LOCATION 02-07-07 THE WATER SUPPLY, WELLS AND CESSPOOL
�'.' y IA- REVISE HOUSE 12-6-06'. LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS
AND OR DATA OBTAINED FROM OTHERS.
o.i AREA: 26,701 S.F. OR 0.61 ACRES ELEVATION DATUM: ASSUMED
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UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW COPIES OF THIS SURVEY
4,o MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN
•s, ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION