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HomeMy WebLinkAboutKlotz, Robert • OFFICE OF THE TOWN CLERK �FF0/A- Town of Sputhold DSO OG Judith T. Terry, Town Clerk Town Hall, 53095 Main Road P. O. Box 1179 Southold, New York 11971 Telephone4! * ' (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 225 Residential • X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: NAME: Hedwig Zervos ADDRESS: P.O. Box 2035 • Orient, New York 11957 DESCRIPTION OF PROPOSED- CONSTRUCTION or ALTERATION New Single Family Dwelling with Cesspool System - APPROVED as per Suffolk County Health Dept. approval --LOCATION OF PROPOSED CONSTRUCTION or ALTERATION: OWNER OF PROPERTY: Robert and Miriam Klotz OWNER MAILING ADDRESS: 16 Country Ridge Circle Rye, Brook, New York 10573 OWNER PROPERTY ADDRESS: The Strand Lane East Marion, New York 11939 TAX MAP NO. : Section 30 Block 2 Lot 55 CROSS STREET: The Long WAy BUILDING PERMIT NUMBER CROSS REFERENCE: Judith T. Terry Southold Town Clerk DATE : September 4, 1987 (TOWN SEAL) • �o����C ff UL,r • (74 '1 Q ��,�� Town Hall, 53095 Main Road y'�Ol .��� �' P.O. Box 728 '�...w. ilii i� Southold, New York 11971 .11 mull.mon' d\ TELEPHONE I( \( I I RK (516)765-1801 PEWS"! OF VITAI.STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD September 3, 1987 To: Victor Lessard, Southold Town Building Department From: Judith T. Terry, Southold Town Clerk Transmitted herewith is a copy of application No. 228 for a CONSTRUCTION or ALTERATION Permit for a cesspool or septic system submitted by Hedwig Zervos for Robert and Miriam Klotz • 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. • 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 — X DISAPPROVE — COMMENTS: Q4 e. y CI,, \(/,:iikA.? 24:°c1j ' Signature °\\ 44VV1 Date _ - OFFICE OF THE TOWN CLERK ,,c FOUL Town of Southold � 441 Application No.o?o/ Judith T. Terry, Town Clerk Town Hall, 53095 Main Road Construction tn P. O. Box 1179 Southold, New York 11971 .�� Alteration Telephone 01 t 0".. Residential (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 $ 1©.. p© DATE �eP'st. 3 L941 APPLICANT NAME: \ `. APPLICANT ADDRESS: (Ft C1 114eryD 35 SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION C©vis-rUC_r1 ©\ m o, Si©r' ) Q � LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: R©‘c) ./-" '(`'I1Y't&W KBO Z OWNER MAILING ADDRESS: 1 ( co„„ii fz ,ice Circle. 13rook ) N . `/, 10S-73 OWNER PROPERTY ADDRESS: I \Ne StrzA Lave L-Q.sk Rcxrtovl ML / 11939 TELEPHONE NUMBER OF CONTACT PERSON: 3�3 — Q_rj ,C TAX MAP NO. : Section 030 Block Lot 5 S CROSS STREET: —VA BUILDING PERMIT NUMBER CROSS REFERENCE: '— kms;, Sigrure of Applicant RECEIVED BY: / � , •Ld '►Town o erk's office DATE: SEP 03 Town Clark Scuthi d I \. ,,,, \ \ ...., .5 1 A 40 ,i),\,‘\ 0° . . \ ?. A6ReWD E \ N C .1 fie. i/// bi. /OOFNC 4 V. • SIE •G9 M>��P \ N , . % i / \\O' ' / N Of IS /X98) h t/ at,' is. L N <>if Nfmay�fPr � r d , ., ; x . , . . SFR , $ .- t •; :. 9 :k., i ;: 9 s t- �tl.s,.,,.. t aa'..� i i..., .i i'.; r:h)f I It.,),-;\ l i•r. '..1f f'.',1-71.i4t .r : 4 ii, 4 P PO A SURVEY FOR +� HEALTH SERVICES , OF _ ENT � �� . � .DEPART* Vilbr,•'iliriagiql .,� t -�' �.,�' itCOUNTY w ✓suFFOLK gm ROBERT KLOTZ 8 MIRIAM KLOTZ +�, �� L',� a.��� E3�� lStf�ii ruit3li `'�itLOT 113, MAP OF PEBBLE BEACH FA Mg FOR APPROVAL OF CONSTRUCTION ONLY AT EAST MARION • DATE: JULY 8,1987 �( OCT. I• ,1980 GATE 7 "� HS REF. NO. `l `,(, I TOWN OF SOUTHOLD SCALE' I"=40. • NO. __------ __.__L 80-522 R SUFFOLK COUNTY, NEW YORK Ac .nvFn r i *UNAUTHORIZED ALTERATION OR ADDITION TO THIS GUARANTEED TO: SURVEY ISA VIOLATION OF SECTION 7209 OF THE CHICAGO TITLE INSURANCE CO NEW YORK STATE EDUCATION LAW ROBERT KLOTZ 8t MIRIAM KLOTZ *COPIES OF THIS SURVEY NOT BEARING THE LAND (f ) 7 (.(s P ( , ) SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL �E OF /yF � NOT BE CONSIDERED TO BE A VALID TRUE COPY qP ,.. *GUARANTEES INDICATED HEREON SHALL'RUN ONLY TO S `0 HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT AND ON HIS FOR TO THE TITLTHE E COMPANYGOVEDRN- ex / �O 9* • * NEAREST WATER RAIN M1.! *SOURCE OF WATER: PRIMATE_...' PUBLIC / MENTAL AGENCY AND LENDING INSTITUTION LISTED . f 0 SUFF CO. TAX MAP Den 1000,SECTION 030 BLOCK 2 .LOS HEREON,AND TO THE ASSIGNEES OF THE (SENDING *THERE ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY . INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE ;w., •t O - OTHER THAN THOSE SHOWN HEREON. TO ADOITIONAL INSTITUTIONS OR SUBSEQUENT 1E4i♦l5% - * AN THE WATER SUPPLY D SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE OWNERS 1 WILL CONFORM TO THE STANDAR OF THE SUFFOLK CO TY DEPARTMENT *DISTANCES SHOWN HEREON FROM PROPERTY ONES A.. OF HEALTH SERVICES. &./ ` TO EXISTING STRUCTURES ARE FOR A SPECIFIC APPLICANT, s•I< PURPOSE AND ARE NOT TO BO USED TO ESTABLISH <i p� 9 MiRIA�M 4 R. Ler kt.o rz PROPERTY LINES OR FOR THE ERECTION OF FENCES <ti �X 4589 ADDRESS �F / F10• % •• '' ' atN�!' 4ND TUay f�,.�c�t !U o_ TEL. t4 3 l0 400 • -/.1 •ER AVENUE s `� 9 YOUNG YOUNG RIVERHEAD, NEW YORK ■+MONUMENT • SUBDIVISION MAP FLED II THE OFF ØF fl4 RK OF3JrpQ(J( iy ALDEN W.YOUNG,PROFESSIONAL ENGINE ER ON JUNE II,1$75 AS FILE NO.$264 AND LAND SURVEYOR N.Y.S.UCENSE NO.12845 HOWARD W.YOUNG, LAND SURVEYOR ••TIE.LOCATIO•I OF WELL(W),SEPTIC TANK(ST)B CESSPOOLS(CP)SHOWN HEREON N.Y.S.LICENSE NO.45893 ARE FROM FIELD OBSERVATIONS MOOR DATA OBTAINED FROM OTHERS oNG WAY R- 0o THc L v L o. 5'646' 11 00�0 1•' 0�oil: o a"° O 06' ask. 6� 5 / Nix. Z O 6101 it• -.= ::;::--- Z7 -..., 6- t iii $660:3P ft. , 95 04• ii 7 lJ P -ad ' 36o29 2 is'-se �\od3 5 oa, �- • 31 12991 '$�� 36'1l• ��'.,�, 1030 ,,E. s9�, -a �3 260 48 41 0\$l4 �6I 5 2 dot ��72 5Q ft ''� \ N oo + Are°' X29 36 jG: 1J'4 OS �6 e6 012 /- .., \�o>1; '+ $.26 26 0 bio, \\ /