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HomeMy WebLinkAboutZellner •ii° COM(i . Town Hall, 53095 Main Road �® P.O..�,�� Box 1179 - ®. .1 aft �`a®�r�� Southold, New York 11971 JUDITH T.TERRY ---�.7„„o�' TELEPHONE TOWN CLERK (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. 668-R Residential X Non-Residential Fee $ 10. 00 Septic Cesspool X New X Existing Name Of Owner ZELLNER, RUSSELL J. Mailing Address 1 975 HORSESHOE DRIVE City St Zip CUTCHOGUE NY 11935-0000 Property Address 1 975 HORSESHOE DRIVE City St Zip . CUTCHOGUE NY 11935-0000 Owner Telephone No. 516-734-7060 Tax Map No. section 95. 00 block 4 lot 18.0301, Cross Street COUNTY ROAD 48 Date Of Last Pump Out 0/00/00 Issue Date: 4/18/88 Judith T. Terry Southold Town Clerk (TOWN SEAL) Is OFFICE OF THE TOWN CLERK fall Town of Southold �� � . . X% Application No. 6 , t, Judith T. Terry, Town Clerk ^„ Town Hall, 53095 Main Road Residential P. 0. Box 1179 cn •`' Non-Residential Southold, New York 11971 Telephone (516) 765-1801 TOWN OF SOUTHOLD • SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 6C1 Fee $ / /s) V DATE 1-7—/ a— ,F38 OWNER NAME: (a) s S2jJ 3 2e-///V ,SK_ OWNER MAILING ADDRESS: Cr) J/QeS'e GODk((ie C-1- -CJLQ , ( - In3� OWNER PROPERTY ADDRESS: 97 / se 5/0 D,ei°lJ • C-4, (0. N- y, f lq` 35- OWNER TELEPHONE NUMBER: MTC 73c/ — 7060 (000 TAX MAP NO. : Section 091-- Block ©t/ Lot M, 3 CROSS STREET: COo/11 Raft-C) CN/ Y TYPE OF SYSTEM: Septic Tank New ) Existing Cesspool New 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.) Signature f Applicant / RECEIVED BY: fA,, / awn ' I L'rk' : Office DATE: 7/049/C8- X00'' vP /40/00 Sec) Ovill OI s.7Tl — /17� C rz,'t �f/�L/1nyr� e x.,7;;,,,, 1 biy -,,`// J3 T 4)0,77 r2P�i r E-C//c t/S'-2� , Tti...he water supply & sewage disposal sys- a.,;%- • , terns for this residence will conform to the 1 standards of the Suffolk County Depart- 5 tih et, ment of Health Services. 56 ", CJQ vNa \ ' y -i ,,t- , p di GOL 3‘ oohs �. LO'f ceps P I I y `�{ a '�, O 56 t \TI.,)•C-9:5 0 32 \ \ � k► -0, N �01 -------..,s,, \\`� seek y0 yV 14'6A Ted r" ft o s% \10 Se K e, rkk• 36' 6' , wa , p �j 11' 65-' •i• . LSN �A toE LOT 30 n 06 9. a a; 2 t] _ p ,�/� 44.86 "3 ; \cly- \ . stk #\I l\ 36 \ ' sef 15 is • ' 0 \ / cP ‘n 13 '31-°NA ,'- V,e_1()4 4 , / . . ; -i . 4, % . q, 0, • _ ,4 /.\ .ser/7-c41. r'd!, '0% r 216, o ,t�. m # '• i/• lZ.sH sf/! /3 ilial.1Rthe n ez c V� 3��1 O4 �/♦ .� ie�:i .c�r � , t E• yws7nYef tin(11 ♦•' '.�"i;r fir -, a ' _-'• x,� .I •v... (♦ ♦ 6 `p ir.'44�• -0 JF a< T.-.--_. .a`:1.'..::::• j:::,�•••r`}- ii:a it��•!•='• 'In't (�"' 7PP ` �r dT'��/r�r''^ '`est�i� -•r:,�t_' i, -m�^!3t•.1• �,r.,� ....a..:1.° 6 _ �y coZik:ii, �C.i+ii: i 1.i3;.::'i,:lii ai d on �; --...., - / / 7- ad/A-4 --- r`bp, N / \NVi --------1•-..-GPIgn tore- ' _ .- t. ft • o_ / ‘m. ..N/ q0° \C;%# 0. 0• .. ' /11, y ‘/CV V ti 93° 4G<•° 4 t�Jtt��°� 5' SURVEY OF ei. tiF °�' sof LOT 30 9cq •c9`9, sfk . �L � + LY Dl�tEM11V �p� �! AQF OREGON VIEW ESTATES ° �il� som D - OFLED APR. 4, 1975 FILE NO .6241 gX)1Bg$ TWQY5Alt `c%} AT CUTCHOGUE . TOWN OF SOUTHOLD - AREA = 49, 297 SQ. FT. SUFFOLK COUNTY , N . Y. __ __. ____ 1000 - 09 5 - 0 4 - 18. 3 0 I ✓p ?.. �.. ,,.c?-TY D�vP/�,:;TMENT OF HEALTH SERVICES =i FC-R A FRC,,, OFF CONSTRUCTION 01r,,_Y - SCALE I" 50' . MAY 9 , 19 8 6' • = ' .=,;; DATE �6 I � REF. `�0 r' ) JAN . 16 , 1987 ,,-., n"� FEB. 5, 1987 APPROVED /I/r�/ Ire +' i;t . - ! = S �`� CERTIFIED TO • e. a:� -` '21. •• • Prepared in accordance with the minimum "`� t FIRST AMERICAN Tq .E standards for title surveys as established by 1 N S UR A N C E COM PA I .. the L.I.A.L S. and approved and adopteo 0 F NEW YORK. cij - `' �0 L A NL) for such use by The New York State Land LONG ISL AND MORTGAGE CORP „ �a5 QN A.£�N C,,p •itle Association. . R U SS E L L ZELLNER �,4 05``: /.i ,..G . L� MARLA ZELLNER /: , ,, .Y.'S. LIC. N0. 4966 8 i - P'E 0 I k E n . a ENGINEERS , P. C. ii- ('51 •\�'`.9' 6,1,5 — �0•e♦P ELEVATIONS ARE REFERENCED . MAI NN. • N � �° TO AN ASSUMED DATUM . �' THE LOCATION OF WELLS 8 CESSPOOLS SHOWN SOUTHOL ' , ' .Y. 1197 I HEREON ARE FROM FIELD OBSERVATIONS AND . . DATA OBTAINED FROM DTHERS ' 86 - 261