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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK �+ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
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MARRIAGE OFFICER �� Fax (516) 765-1823
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`�,® .r Telephone (5 6) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 2004-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner MATZ, GARY D. AND EILEEN C.
Mailing Address 1 P. O. BOX 1300
Mailing Address 2
City St Zip CUTCHOGUE NY 11935-0000
Property Address 1 1340 DUCK POND ROAD
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 516-734-5817
Tax Map No. section 83.00 block 4 lot 9.000
Cross Street OLIVIA LANE
Date Of Last Pump Out 0/00/00
Issue Date: 11/13/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
'
OFFICE OF THE TOWN CLERK 'c��FFO(,(���' ,
Town of Southold CQG' Application No. q2c1//
Judith T. Terry, Town Clerk $10.00 - Residential
Town Hall, 53095 Main Road
P. O. Box 1179 cry � r i:,-"' i $25.00 - Non-Residential
Southold, New York 11971 O4 �' ��`
Telephone j �0'�
(516) 765-1801
• TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ 10000 •
DATE OC% '\ 3 )01012
OWNER NAME: ccc ' Do 0,0 el 'El L EN"
OWNER MAILING ADDRESS: �{�,(°) . �X \-SOO
C,uT C-10 LAE N 'Y ` 0 °C- 5
OWNERPROPERTY -ADDRESS:- \ �� d 1h,Ct aQ �- --
e-JU 110G1.9l\J"( ') \®1 355
OWNER TELEPHONE NUMBER: q' 3 - 5S-3, '1-
TAX MAP NO. : Section 08 S Block Li Lot "1
CROSS STREET: OL OLiviiq L A N F_'
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool / New Existing
Residential V Non-Residential
DATE OF PREVIOUS PUMP-OUT:
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.)
ignatu e of Appl' nt
RECEIVED BY-:
Tne k's Office
DATE:
NOV ':) 1g9?
- N Town Clerk Southold' •
I ,
S.C. TAX 'MAP NO. DIST. 1000 SECT. 083 BLOCK 4 , LOT 9 ' FILE IVO. 9//'/ T PROJECT NO. 92C485
LOT 0 VERTICAL
DWELLING SAND DRAIN
S 39'00'00" E 150.00'
'w YON
a
O 20' DRAINAGE EASEMENT 00
0
N. N.
p I O
N CV
n
12.3 MEL.
LOT #8 \ g LOT #10
' VACANT \� VACANT
o
I R \ a .
NORTHWEST END OF HOUSE
MA imI jji lu n
W 1.� 327r
2,4 1 263 11.9.1:,
Z 3't� 2 STORY
7.tY �_
Z� NED
JJNDLNc
40 14.4 „ r 24 343.0'>0 I w
b C.P.a o
OR O
O ; O
P P
* R=25.00' n n
L=39.27' Z 20' DRAINAGE EASEMENT to
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fo r l
275.00' N 39'00'00” W 150.00' FSE Wfv.
DUCK POND ROAD (49.5')
o NYT 90 Olin se
9lED
Unauthorized alteration or addition to this document le a violation of Sectio, 7209 PROJECT: FINAL SURVEY OF
of the New York State Education Law.
Certifications Indicated hereon shall run only to the person for sham it is prepared LOT #9
and on his behalf to the Title Company, Governmental Agency and Landing Institution MAP OF WOODBINE MANOR
listed hereon, and to the assignees of the lending institutions or subsequent owners.
Copies of this document not beoAng the professional'.inked sed or embossed seal
shall not be considered a voild true copy.
The offsets (or dimensions).horn hereon from structure, to the property lines are SITUATE AT: CUTCHOGUE, TOWN OF SOUTHOLD, N.Y.
far o specific purpose and use and therefore ore not Intended to guide the erection of
L fences, retaining wail., pool., patios, planting areas, addition to buildings or any other
construction. DATE: ,,OCTOBER 1992 SCALE: 1n = 50'
OWNERS: . GARY D. MATZ & EILEEN C. MATZ SURVEY DATE: OCTOBER 1992 AREA 40.500 SQ. FT.
P.O. BOX 1300, CUTCHOGUE, N.Y. 11935 (516) 734-5817 FILED MAP NO. 8239 DATE FILED DEC. 15, 1986
GUARANTEED T0:THE BRIDGEHAMPTON NATIONAL BANK FIELD, BOOKS DATA DISC FNLSURV.DWG
AMERI •N TITLE INSURANCE COMP
/ i I FND. 7/30/92 UND. CONST. 9/15192 FINAL 10/2/92
CERTIFIED BY ..ffP ' / /- - 1.
PREPARED BY STANLEY J. ISAKSEN, tit, UCENSED LAND SURVEYOR
TANLEY J. I A SEN, JR., N.Y IC. NO. 49273if\
® P.O. 90X 294, NEW SUFFMX, NEW YORK 11958
DESIGNED DRAWN G.D.M. CKD. S.J.I. PHONE(519)734-5835, N.Y.S. UCENSE No. 49273 LS.