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HomeMy WebLinkAboutBancroft, Martin Jr /ow AM/ 0 O ELIZABETH A. NEVILLE 1 h`Z` t N Town Hall, 53095 Main Road TOWN CLERK p P.O. Box 1179 , y Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICS rft1 Fax (516) 765-6145 MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER =y�fO 4O, ,.I Telephone (516) 765-1800 FREEDOM OF INFORMATION OFFICER = �'1 ;.. • •il OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 2083 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : MARTIN BANCROFT JR Address 1 : PO BOX 483 City St Zip ORIENT NY 11957 Descripton of Proposed Construction or Alteration SANITARY SYSTEM FOR SINGLE FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. REF #R10-99-0043 Name Of Owner BANCROFT, MARTIN JR Mailing Address 1 PO BOX 483 City St Zip ORIENT NY 11957 Property Address 1 38099 MAIN ROAD City St Zip ORIENT NY 11957 Tax Map No. section 15.00 block 2 lot 16.000 Cross Street GREENWAY EAST Building Permit Number Cross Reference: Issue Date: 5/25/99 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) „�S%FFOL -�' • ELIZABETH A.NEVILLE , ,.Z�� OG Town Hall, 53095 Main Road TOWN CLERK 1 k P.O. Box 1179 N Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICS % Pr, 'r MARRIAGE OFFICER Fax (516) 765-1823 RECORDS MANAGEMENT OFFICER Z #4, ao� , Telephone (516) 765-1800 FREEDOM OF INFORMATION OFFICER 1 ligl` • OFFICE OF THE TOWN CLERK i, TOWN OF SOUTHOLD 9 'll rqg - ' mi TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: May 20, 1999 Transmitted herewith is a copy of application No. 2171 for a Cesspool/ Septic Tank Construction Permit submitted by: Martin J. Bancroft, Jr. Please review the application and location map and advise if the project has received Suffolk County Health Department approval and if this office may issue the permit. Please complete the form below and return it to me. Thank you. Linda J. Cooper * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE ./ DISAPPROVE Comments: (,\ gnatur SI .--`(/c i Dated OFFICE OF THE TOWN CLERK ,,,, 1TOWN OFSOUTHOLD ,� �� �Q 0 Application No. 4171 RI.I7ABETH A.NEVILLE,TOWN CLERK ` P.O.BOX 1179 Construction SOUTHOLD,NEW YORK 11971 ; v to Alteration Telephone ,j ifor.� • $10.00 , Residential (516) 765-1801 -74/ � ��'� -Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. (Q08,3 Fee $ / DATE E/C9'--13 / 9 9 APPLICANT NAME: ►L t APPLICANT ADDRESS: P , O • j�� D� SEPTIC /CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION New dweiff(3. LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: V G , C tib .. OWNER MAILING ADDRESS: i' . Q gjO?( - 3 E ) y \ a5 3 OWNER PROPERTY ADDRESS: 3`aOCA IAAF � . C7) K) TELEPHONE NUMBER OF CO TACT PERS : L} C�'-��3 C Ea)) \ oo � © I � TAX MAP NO, Section 5 Block Lot CROSS STREET:.j-- TREET:.,r- AN_LO ee„,_ BUILDING PERMIT NUMBER CROSS REFERENCE: g/(71"414"ofppli nt RECEIVED BY: Town CI r 's Tice DATE: 6-72,0 • I ' *SONS Ref* RIO-99-0043 SURVEY OF PROPERTY AT ORIENT TOWN OF SOUTHOLD jrSUFFOLK COUNTY , N. Y. j Of-1k SND 1000-15-02—sits - - 1 1-1` SOUND SCALE: 1* = 40' MIL It 11129 i 11E / fvb. 5, 1999(rw.,101) AP',- N., 199 9(x. , ,o, ,-- •S 81'J8.5 D E uNE Z A 101.580 1M.H.W.M. a. \ 0to o ,�. g '�\ g 88 t / _- a.er C 11-7.0 bilme of tit d beat 4 21.•23.6' {1-26.0' - ♦ nix Can,f0.1 Ero„,„ O % \ Hmz6Ia. LMC .\ 1 0.3'W 0 0 oCERTFED TO' ,. MARTIN J. BANCROFT, JR. A -4- No c w i --•• / am hinter with the STANDARDS FOR APPROVAL 1 AM) CONSTRUCTION OF SUBSURFACE SEWAGE '.”' •`"1 DISPOSAL SYSTEMS FOR SNGLE FAMILY RESDENCES Zo and will abide by the conditions set forth therein and on the • _.___ permit to construe. • i favor ss a5' The locations of wells and cesspools 0 — ---' j 3 shown Arson are from field observations o and or from data obtained from others. 8 r_ N a),..0 04 w 3-4 SUFFOLK COUNT?DEPARTMENT OF HEALTH SERVICES t F- a» PRIMP FOR APPROVAL OF CONSTRUCTION FOR A �� w c a SINGLE FAMILY RESIDENCE ONLY "11 b, itch Q 1-r 6t-za.e' Q O DATE 3-6-c/°/ REF.NO. Rio--9-0.N3 asw S 8753'30" W 100.00' I a APPROVED , PP' / /\_ I D CD FOR MAXIMUM OF*$::0R•0 M i N/ON1F ROZANSKY .E-p EXPIRES THREE YEARS FROM DATE OF APPROVAL •.. N C • (vacant) a 33 1 o• EXCAVATION INSPECTION REQUIRED 8 FOR SANITARY SYSTEM '1N: ...5 4BY HEALTH DEPARTMENT 1 v -—-1, Drown Nom Isom 01. AREA : 29,546. eq. it. I Brow loamy(day a to tie line a -—-d •—PIPS I arm. *ism wad with heavy grovel ac •-MONUMENT 00 • -— ILEV�lD= REFERENCED To Olt. s... Ow to*nem wad 811 MEAN SBA LEVELQ Aj) terCavy}e,/ •Eroy/04 Hazard L-fle iwo TEST HOLE Awn/ Cm..of4./ trove, //61E.aJ N. Arr.- 0.1$ ..°E NE* May, Photo N 4fa-4,64 -1,f r, • + t 4je 'if P/, i. !' ' .Y . UC NO. 49618 ANY ALTERATION OR AUDITION TO THIS SURVEY IS A VIOLATION ' :'NIC tt" OR., '.C. . OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW7(j..111 '20 1 EXCEPT AS PER SECTION 7209-SUBDIVISION 2 ALL CERTIFICATIONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF P. s;'-..‘.;'1111/4,a,' i_CAI< •••% ,..e SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 12 Z i• .'• ET Q Q C MHOSE SIGNATURE APPEARS HEREON. SOU Ti•�d i1 1971 VV tJ