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JUDITH T.TERRY o Town Hall,53095 Main Road
%TOWN CLERK c@g g P.O.Box 1179
REGISTRAR OF VITAL STATISTICS �\
��' Southold,New York 11971
�Q �� Fax(516)765-1823
MARRIAGE OFFICER � �i �'L, ��`�` �1
RECORDS MANAGEMENT OFFICER : ®I `1; pfd Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1208 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PETER F. HRUZ
Address 1 : 27 PHEASANT VALLEY DRIVE
City St Zip CORAM NY 11727
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY
DEPARTMENT OF HEALTH SERVICES. SCHD REF. #93-S0-59
Name Of Owner HRUZ, PETER F. AND JOANNE M.
Mailing Address 1 27 PHEASANT VALLEY DRIVE
City St Zip CORAM NY 11727
Property Address 1 MEADOW BEACH LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 17 lot 17.019
Cross Street NEW SUFFOLK AVENUE
Building Permit Number Cross Reference:
Issue Date: 9/15/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/,, /Ill., / 0
(Z, O , tmay_`
1 O 1�
JUDITH T. TERRY .4. • Town Hall, 53095 Main Road
TOWN CLERK ® r ri 1 P.O. Box 1179
VA • w � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 1Y® I Fax (516) 765-1823
MARRIAGE OFFICER •�` ®I�• Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER QJ N
FREEDOM OF INFORMATION OFFICER „,,,,/ ����
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD 1 i li
TO: Southold Town Building Department a ' \i; FP 4 i i'
FROM: Linda J. Cooper, Southold Town Clerk's Office _ .._F
DATED: September 12, 1994 F'DH, TOWNO6 TOL®.
Transmitted herewith is a copy of application No. 1253 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peter F. Hruz
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 recommeenndations:
APPROVE v
DISAPPROVE /
Comments: 9f , 6"e, ,,,,,,, ,,,,i1"9,5--- So f
, /
_,: / / '
Signature
• Da eG 7 if*d‘i .
,
I
OFFICE OF THE TOWN CLERK S�FFO(1
Town eof Southold 0�� : 4`` Cil/
Judith 7r, - ; Application No. 49..S
Terry, Town Clerk •C
Town Hall, 53095 Main Road ` c Vii,• Et : 'fin Construction c..------
P.
�
P. O. Box 1179 .'`�vJ Alteration
Southold, New York 11971 ,�
,�j `=ad �� Residential
Telephone
(516) 765-1801
Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION •
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
,
Permit No.
Fee $
DATE 94,1,,q
APPLICANT NAME: pE-,--._ r /.--f jQ(,(
APPLICANT ADDRESS: 07 P sl V/'rLL& - h'-
�2/4-/14, !U . F in a7 u
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
N6V DNSILy 6146ZL//4
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: /Ere--4._ r F 30A4N6- M meu2-
OWNER MAILING ADDRESS: 97 /O/7 ,017JV t/4LL ,)L
(p), rn , N,y 117 g7
OWNER PROPERTY ADDRESS: 111011)04J Z64-e// L 4-A/G— GAIT D-0
m /1-7-7-r 7V!K /L '/ ,.
TELEPHONE NUMBER OF 'CONTACT PERSON: c(6�65T•-5-- s. -- Cl"Cm2 _H24
TAX MAP NO. : Section /1 c Block /7 Lot /7, 1
CROSS STREET: /U C) 5u je-/ Avr
BUILDING PERMIT NUMBER CROSS REFERENCE:
. Ii., tr:4, --
_ - Signature of Applicant
RECEIVED BY: - GC)/(14- L----
Town Clerk's Office
DATE: ?''l ' �• /5 L/ -
',Y '-- '*
$iL0r PT Y), ;::°`-'0111-),
F 0��\1 41r t�'. 9 r 4
21901
/2 10r� r
\-\ Lot 27 ,
\\ (DWELLING I00'•) 1
Fif
_ Lot 28
62 3cr (VACANT)
26 5.85°08'04'E
(VA 140.98'
VACANT)•
, EL 18 0 __
�k 1 EL=158,
0
01 NI Lot 25
010 I Area=42897 s.f.
coI
•a
A -A
�•"10,
°/ N\ Qn QC q \
o \4 / y9isF
�v// 6s, SFS - ---75------ Lot 24
�`. \/U v./ FE 0 (VACANT)
�/ `J Jho- ` /Se/ Z(
4,
\ OQ P� wa fr1u57� ,6 e_
/C�O ayy>1 OQp Q*4 //(/S/,'eG 67/ 4 r'.2/ �'Ps
\ . V•.(' /r�o✓ � 6, 64////noi ,
/,,9Cg�l 0�9� `
.451
F9
'9� -1. F',
/ i °
X1, V p\ W
0
NOTE• J \
I PROPOSED DWELLING SHOWN HEREON /
IS LANDWARD OF A LINE 300 FEET FROM t 04i>
R=2500, `R05000
THE TIDAL WETLANDS AND THE PROPOSED 0.77 5
DWELLING IS ALSO LANDWARD OF THE 10 1.+.0 LL=229
FOOT CONTOURS
2.BASED ON THE NEAREST TEST HOLE, EXCAVATED 'D0
FOR THE SUBDIVISION APPROVAL', THE GROUND „� <•
WATER ELEVATION IS APPROXIMATE 20 FEET s
ABOVE MEAN SEA LEVEL (MSL). D
3.ELEV 6 I DNS S OWI92 EREON ARE REFERENCED
).
sues FAMILY OWEtING ONLY
EXPIRES THREE YEARS FROM DATE®F APPROVAL -
SURVEY FOR
PETER F. HRUZ 81 JOANNE M. HRUZ
sU€SOCK COUNTY GehAtruita OF HEALTH MIME: LOT NO. 25, HARBOR VIEW ATMATTITUCK..
AT MATTITUCK DATE: JUN 15, 1993
FOR APPROV L OF CONSTRUCTION ONLY TOWN OF SOUTHOLD SCALE I°= 5,00;
�/ /� 9 ( N0. 93 32
N / �3 S� _ S✓ SUFFOLK COUNTY, NEW YORK
DATE H4 RfF. NO. - - -- -- --- - -- -
�. .,Nd�rNoNirt0 ALYEA.),OH OR ACO,TII,H r,• tHFi ;CERTIFIED TO
7 i StlAvFY rs A .iot,T10N CA SF:T'CR Tzov Cf THE • PETER F HRUZ
/� rr. i,-PH ST.tr EDUrAT'Or.,to JOANNE M HRUZ
APPROVED ! x THIS S,IRVEY NO' BEARWi r4E(ANO SUFFOLK CO, o`""�=z AL BANK
,//�i`�✓'; S iR:"OR> ',ACE Co SEA( C°TNI' " SFAI 5Hn FIRST AM 0' •p: �`t• RANCE
...--2-.-1/1/41—
/L L I w• i SE "u S10F AEC TJ BE c vrl •N,I. :ruT iF Y�: .r4... ...-
____,
��!•
V')UAHANTCtS INO.(AT(' NFSEOL .NALI- AIN(NLT ;T COMP'OA •-1
(i-i: %fri.'M ,ON Wr,Ok Self SJRti•EY I<. HRFHAREI, I ,_ow. —
HEALTH DEPARTMENT-DATA FO AP°t,O.S 10 ::7NS1RU:' I{ 0$C' ,y, HIS S()HALF '' THE TITLE COMPAN) GOVEPN- Y. :' Q
N NEAREST WATER MAIN 'I+ WATER PR,Vf rF-.--PUB,_ICX t HENTAI ACENCH AND;ENDING WST$IU NION LISTED I CO . \N' -
Jig. H•FE0H ANC TO THE ASSIGHFFS Or ,"E LEROING L•.1 b 0
N S{!f CO TAP YAP Os(f000 •(.' + I'l —.iLGCF .1Z_L�_T-.ILL. y O '
N THERE ARE No DWELLINGS WITHIN 100 FEET OF THIS ►ROPFRTE IRS T 1 Tl,TICrI GOARAH TEES ARE NOE T&AHSFEFA BLE T = Yr ��;4 Ah
ht THAN THOSE SHOWN HEREON ! TO AOOITIDNAL IHST.TOT•OE/S OR SUBSECUEHT a1.Ffg:�'�^.hht
I THE WATER SUPFLY AND SEWAGE DISPOSAL. SYITEN FUN THIS RESIDENCE 'I DIENS I 3S••.;"{`find j
WILL CONFORM TOYTHE STANDARDS OF THE 5d'FO[a COUNTY CEPART.01NT *DISTANCES NCEI SHOWN HEREON FROM PROP C,F'RTY I-IVES 11 _-y.,;�y. --+
II Too Ex%STING STNUC TUPES ARC ON ASPEC IF'C •/ 2 CA
OF HEALTH SERVICES I PURPOSE AMD ARE HOT IO RE USED TO ESTABLISH I l/o :J
APPLICANT: ) PF,',PERTY :INEC OR F!IR THE ERECTION Of FENCES I • v
PETER. F. F Tc ANNE IT. HR.uz \ S�)A'
ADDRESS ry `-LAI S
�q w rca-N u 5 2EE N •-. • " •NDER AVENUE
Cu2E4m, N-Y• 1171-7 �`L 414 S°+D ( -__ YOUNG a YOUNG RIVERFlEAD,-NEW YORK
NOTE'♦=STAKE FOUND =
=MONUMENTFOUND STAKE SET .. J I "
ALDEN W YOUNG,PROFESSIONAL ENGINEER
•
SUBDNISION MAP FILED IN THE OFFICE OF THE CLERK OF AND LAND SURVEYOR N Y-S UCENSE NO 12845
SUFFOLK CO.ON AUGUST 21,1987 AS FILE NO.8377 "
HOWARD W YOUNG, LAND SUAVEfOR
M THE LOCATEDM OF MELLOW),SEPTIC TANN(ST)BCESSWOOLS(CP)SHOWN HEREON N Y S LICENSE NO 45893
ARE FROM FIELD WSERWITIOMS AMO OR DATA OBT/NMED FROM OTHERS
W.S.
BRAND'S & SONS INC. •