HomeMy WebLinkAboutSchlumpf Town Hall, 53095 Main Road
sr P.O. Box 1179
__ ®� "NT' Si. Southold, New York 11971
JUDITH T.TERRY �,�� yr'�� � FAX(516)765-1823 •
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 1242-R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
New X Existing
Name Of Owner SCHLUMPF, RICHARD AND JANET
Mailing Address 1 241 WILLETTS LAND
Mailing Address 2
City St Zip WEST ISLIP NY 11795-0000
Property Address 1 POINT PLEASANT ROAD
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 516-298-1666
Tax Map No. section 113.00 block 9 lot 12.000
Cross Street SILKWORTH ROAD
Date Of Last Pump Out 0/00/00
Issue Date: 9/12/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
a
,,. .
OFFICE OF THE TOWN CLERK 0CSFO(,r"'-
Town of Southold �% r - Application No. 1c2—
Judith T. Terry, Town Clerk ' "� �+
��'�` <�r:�_� .0%1 $10.00 - Residential �'
Town Hall, 53095 Main Road r`
P. O. Box 1179 cra
r: $25.00 - Non-Residential
Southold, New York 11971 O ® " '.? ' .
Telephone ZQ( 4, `i% • d
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT -
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE q - (-9 -(7
. 'OWNER NAME: ite ittli2i) •F J1-iuE7- ..�/fL„,,,�f.
OWNER MAILING ADDRESS: 4'// (IJ,//,, r< ,1.7¢ .
. (A) --s-r- �.s/, ;43 ,7 I/7 9.s
OWNER PROPERTY ADDRESS: Po rrU TT_ PLG-,r- -7- /e.9:¢
in'9 7117 Z (pi< /1A7//9'c .
OWNER TELEPHONE NUMBER: .5740-11-2,2----16406
TAX MAP NO. : Section r/ 3 Block 9 Lot /c7*
CROSS STREET: _/ / Kwose-�174 2) ,
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool New X Existing
Residential ' , 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.)
'`O 1i
Si.nat re ofAp icant
RECEIVED BY:
warm Clerk's Office
DATE: cFp 1 �, 1q r i
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ALL ELEVATIONS SHOWN ARE REFERENCED TO N.G.V.D.
' (NATIONAL GEODETIC VERTICAL DATUM). BENCH MARK
-\ `\ , IS NATIONAL COAST & GEODETIC SURVEY MARKER -
\ \ • 23731956 ELEVATION - 36.325 (N.G.V.D.) LOCCATED
• \ •
r 22'-0" SOUTH OF CENTER LINE OF BERGEN AVE.,
N. / / } 133'-O" WEST OF-CENTER LINE JUNCTION OF COX NECK RD.
180RING NO. I
\ / / DATE 4/20/87 SURFACE ELEV. 18.25'
/ DEPTH FT. . SAMPLE DESCRIPTION
- ' \N g / I TOPSOIL
. 11 !�' FINE GRAY SAND(HYDRAULIC FILL)
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DARK BROWTRACE OF N FINE SAND AND LOAM
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PROPOSED PRIVATE DWELLING
PLOT PLAN MATTITUCK
SCALE i" a so=o" TOWN OF SOUT HOLD,, SUFFOLK COUNTY,NY
NOTE,
I AM FAMILIAR WITH THE STANDARDS FOR APPROVAL SECTION 113 BLOCK 9 LOT 12
AND SYSTEMS NSFORCTION SINGLEOFAMILYSUBSURFACE
RESIDENCESGE ANDDISPOSAL N MAP OF POINT PLEASANT H MAP NO.720
ABIDE BY THE CONDITIONS SET FORTH THEREIN
AND ON THE PERMIT TO CONSTRUCT. ' APPLICANT: RICHARD A. SCHUJMPF
a
�� 1, JANET J. SCHLUMPP
RICHARD A. SCHLCIMPF , P.E. 241 WILLETS. LANE
DATED 5/28/88/ - WEST ISLIP, NEW YORK 11795
(516) 422-1666