HomeMy WebLinkAboutUmbach, Charles _,�
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ELIZABETH A.NEVILLE � .Z�� 0Gy�, Town Hall, 53095 Main Road
TOWN CLERK c -� 'a� P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ti Pry
Z Southold, New York 11971
MARRIAGE OFFICER � 00 Fax (516) 765-1823
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RECORDS MANAGEMENT OFFICER N.
y,�L �‘ � Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER \-'/91 4, -0„
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1969 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : CHARLES AND NANCY UMBACH
Address 1 : P. O. BOX 711
City St Zip CUTCHOGUE NY 11935
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 #R10-98-0123
Name Of Owner UMBACH, CHARLES AND NANCY
Mailing Address 1 P. O. BOX 711
City St Zip CUTCHOGUE NY 11935
Property Address 1 FAIRWAY DRIVE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 109.00 block 5 lot 14.011
Cross Street WOODWAY
Building Permit Number Cross Reference:
Issue Date: 11/16/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•OFFO4�O
ELIZABETH A.NEVILLE y. r/y Town Hall, 53095 Main Road
TOWN CLERK %� P.O. Box 1179
N Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER Z v Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER ,`4•G �0 ,1� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER :m! * �`s"
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 6, 1998
Transmitted herewith is a copy of application No. 2046 for a Cesspool/
Septic Tank Construction Permit submitted by:
Charles & Nancy Umbach •
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
DISAPRROVE
Comments:
ignatg.LA-"-
if 112495
Dated
OFFICE OF THE TOWN CLERK ,','C,�`FO�x
TOWN OF SOUTHOLD s� G, Application No.0
ELIZABETH A.NEVILLE,TOWN CLERK A,
�;
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 * ;
Alteration
Telephone ,040
tsbir $10.00 - Residential V
(516) 765-1801 - .11' ,,.'' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
Rn
for
NOV O 61998
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL Iowa CCK
Southold
Permit No.
Fee $
DATE ( I 1 /cq
APPLICANT NAME: CA-tke.-a-c tt4
APPLICANT ADDRESS: 'f• - , 6 _moi-- kA (8-(A)
fro AP/ 1 19 I
SEPTIC CESSPO
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
1-k) _c .
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: CH/4-/ t—j fiJA JC y' 1),14,e/1-0-1-
OWNER
pwc f4Cf-/OWNER MAILING ADDRESS: Pb. &/( 7 I
Ca i c t-06-ci C, N. `( / I c 3 S
OWNER PROPERTY ADDRESS: `i4-//zrO,A t f�itrrg
TELEPHONE NUMBER OF CONTACT PERSON: r73L( -
TAX MAP NO. : Section / Block Q j Lot 14. / 1
CROSS STREET: )00a a_v,
BUILDING PERMIT NUMBER CROSS REFERENCE:
(.2,/ z
SApplicant
.A1 di
RECEIVED BY: `� ignatt L
own Jerk' 'office
DATE: /
' d ,
e ‘_) te army'V.
tamer �, $
3
LOT ®DWELLING
E WOOD WAY
$ �a o ii
ra! {�°u H
•
�!.thS. 89/2%0'E. 225.59' I or ar ♦ t
Az n., aq n.me
m `o SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
cov
PRRMIT FOR APPROVAL OF CONSTRUCTION FOR A
y re FAMILY RESIDENCE ONLY
Q DATE_11' ,�� Rid-98-o�a3
i 30 tig
I � �y �MO APPROVED -/
yOil
C.c FOR MA7IINIUM OF_1
A-,C\.1 i p• iii
c o EXPIRES THREE YEARS FROM DATE OF APPROVAL
Li LOT ® I ,ordp.oL,-,vim..'3 e wet .
h , t S� SURVEY OF PROPERTY
s § a y • T AT CUTCHOGUE
z
OWN OF SOUTHOLD
�`�� 9°c � �- 6 g - SUFFOL'lf COUNTY, N Y.
°" 1000 - - - u n
�j
'��° s��i9$` �fa N._' 8 O —: 225.59' CCHARLESD J. UMBACH SCALE 1" sr 40'
0, 4. I NANCY UMBACH JULY 30, WO
°��.% owELLAVO
ELEVA ' ARE REFERENCED
TO AN ASSGED LLA rtA t. LOT
ANY ALTERATION ON Aai1RW ro 771IS.eNYEY RSA MATCH
Or Amon 7009 ori TIE NEW Miff STATE EDUCATION LAK • I am familiar with Me STANDARDS FOR APPROVAL
EXCEPT AS PER SECTION 7E09-E 'W,V P ALL CEATI�R'ATXNS
H9EOMARE VALLI FOR MIS MAP AND COPES TIKEQrOILY F AND CONSTRLICTA7NOF SUBSURFACE SEWAGE . ..of NE 1,
SAV MAP OR COPES BEAR THE M�RESSED XX Or THE SUEVEYON DISPOSAL SYSTEMS FOR SIV6LE FAME Y RESIDENCES W
MOSE SorNTlAE APPEARS I ori and �abide by Me conditions sol forth therein and on the SSP ,T.MerZa t�f,#
ADDITIONALLY TO mar UM SAD LAN TIE 7V 1LTEIED or -pern it to construct. o
AST BE USED BY ANY AAD All SLRYEYNIS MER/Ni A CORY `a'a
Or ANOTHER SLEVErats uw. rows soar As 7ISPEC1ED'AAS . .w.'C5 *
7.I6USHT--T0-ATE'ARE NOT N caou NCE WITH 77E LAR I�,,...0,,
The locations of wells and cesspools f'c ����/ 7 . N.Y.S. LIC. NO. 49618
shown hereon are from field observations <',..' �7N1+.1!:'rr
and or from dola obtained from others. N077:,LOT NUMBERS REFER TO MAP OF 4.--'44,;,7""1_41 - ..-,'' ', OR P.C.
FAIRWAY FARMS'FILED IN THE SUFFOLKf f.!.
COUNTY CLERK'S OFFICE ON FEB. 15,1974 p .. •.9 0 s
AREA = 40,606 sq. ft. • "'B !
.. C.P. FILE MAP NO. 6066 1230 TRAVELER STREET
SOUTHOLD,- N,Y. 11971
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