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4070-01/A•( aRite
Town Hall, 53095 Main Road
JUDITH T. TERRY
TOWN CLERK (1 ) 4, P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 1 Southold, New York 11971
MARRIAGE OFFICER ® o � �� Fax (516) 765-1823
�� ��� �! Telephone (516) 765-1801 ej
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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. 832 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : BRUMAR OF CALIFORNIA INC.
Address 1 : RD 2, BOX 5886
City St Zip RIVERHEAD NY 11901
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 4/7/92.
Name Of Owner SLATKIN, DANIEL AND MARA
Mailing Address 1 18 SEACLIFF AVENUE
City St Zip SOUND BEACH NY 11989
Property Address 1 LONG CREEK DRIVE
(LONG POND ESTATES LOT #3)
City St Zip SOUTHOLD NY 11971
Tax Map No. section 52.00 block 8 lot 3.000
Cross Street LAUREL DRIVE
Building Permit Number Cross Reference:
Issue Date: 5/07/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY j' Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS r CO % Southold, New York 11971
MARRIAGE OFFICER %-; '�® ,it' Fax (516) 765-1823
�® 0 Telephone (516) 765-1801
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OFFICE OF THE TOWN CLER ' '—`77.7P•7:51-',71} `1
TOWN OF SOUTHOLD ,..,,......_-2.__.----:
E
MAY I ® 1992
1b 0 II
To: Southold Town Code Enforcement Officer L,_.bliZ. _,rg_ _ _J j
From: Linda Cooper, Southold Town Clerk's Office TOWN OF SDi31'HOLD
Dated: May 1 , 1992
Transmitted herewith is a copy of application No. 856 for a Cesspool/
Septic Tank Construction Permit submitted by:
Brumar of California Inc. for Daniel & Mara Slatkin •
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.
RECO
Linda J. Cooper 4), ®t,
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* * * * * * * * * * * °- C/erk tv
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I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE X
DISAPPROVE
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Signature
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Dated
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OFFICE OF THE TOWN CLERK OJ�t��(
Town of Southold 0�, ;
Judith T. Terry, Town Clerk �,!'� 6.- Application No. &
Town Hall, 53095Main Road
z + Construction
P. O. Box 1179
Southold, New York 11971 r e Alteration
Telephone 1 x Residential
(516) 765-1301 "�T Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION •
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. S-5-6
Fee $ /6 —'
DATE
APPLICANT NAME: /d1.�2 a 7' `'e,
APPLICANT ADDRESS: ,E.4.02 � S�
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 44-nrec �,,,2�
OWNER MAILING ADDRESS: /é ' 7
S�Jc ,,a' ,/ 47v //9f'
ZOrIV
OWNER PROPERTY ADDRESS: 0�6 ae-A-lC lL /-0 ‘ � "t7eS
TELEPHONE NUMBER OF CONTACT PERSON: 6r76 - 71,2
TAX MAP NO. : Section AC* Block f Lot A.
_ CROSS STREET: L4z..ee/ /
BUILDING PERMIT NUMBER CROSS REFEREArr
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4,ff
Signature of splicant
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RECEIVED BY: AL
Town Clerk's Office
DATE: 5-- l -- 9
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EASEMENT AS DESCRIBED IN DEED � 03-
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TO EDWARD J KADLIC a THEA KADLIC I 'p;
y LI BER 11207 PAGE 562/AND IN DEED TO tr
DANIEL N.SLATKIN a MARA B.SLATKIN..4
LIBER 11269 PAGE I. Lq
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ELEVATIONS SHOWN THUS III �- \ \ -6*- OQ �� ^\v �
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EXCAVATION INSPECTION REVERED i
0
-• SURVEY FOR -
- DANIEL SLATKIN
,UFFOLK COUNTY DEPARTMENT OF HEALTH $ RV!EEi ' LOT 3 °LONG'POND ESTATES, SECT. ONE"
AT SOUTHOLD DATE FEB. 13,1992
FOR APPROVAL OF CONSTRUCTION ONLY TOWN OF SOUTHOLD - SCALE I". 50'
,ATE,1'! I I !,! REF. NO.,- 0- 5.- SUFFOLK COUNTY, NEW YORK NO 92-0107
1 N UNAUTHORIZED ALTERATION OR ADDITION TO THIS
/ SURVEY R A VIOLATION OF SECTION 7209 Of THE
^^oOVED NEW YORK STATE EDUCATION LAW 1PZE OF"Ne
_ ''� �I�L� ___ MCOPIES OF THIS SURVEY NOT BEARING THE LAND S t0
3g ." 00 lO^_. NOT BE„E. .SURVEYOR'S INKE _..e TOD L OR BE A VALIIDSED SEAL TRUE COPY HALL �p,PD W. k• p.1.'( *GUARANTEES INDICATED HEREON SHALL RUN ONLY TO 0 0
TIE PERSON FOR WHOM THE SUMEY IS PREPARED * •r R.c_
HEALTH DEPARTMENT-DATA FOR AP-R0 • TO CONSTRUCT i
AND 011 HIS BEHALF TO THE TITLE COMPANY,GOVERN- - ,.:p.,
N NEAREST WATER MAIN MI • *SOURCE OF WATER.PRPATE_PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED }Stt'.” y
N SUFF CO TAX MAP DIST 1031-SECTION...Q .BLOCK 118-LOT.0.111 HEREON,AND TO THE ASSIGNEES OF THE LENDING �%1,�;,• T
*THERE ARE MO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE ,tion-.`^
OTHER THAN THOSE SHOWN HEREON TO ADOITIONAL INSTITUTIONS OR SUBSEQUENT
M THE WMD ATER SUPPLY ASEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE OWNERS
*DISTANCES SHOWN HEREON FROM PROPERTY LINES A• B
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT TO EXISTING STRUCTURES ARrFOR A SPECIFIC- 04
OF HEALTH 1 ICES - PURPOSE AND ARE NOT TO BE USED TO ESTABLISH f0 le;
PURPOSE
;((Zug 4( avvsliatcwon PROPERTY LINES OR FOR THE ERECTION OF FENCES LARD SU
ADDRESS A! L 7Y„1V7/ .2.2-.57.1-3"--- _ _
400 OSDER• 2tiiQ�P/e� / /✓/y TEL. iic,Ar
RIVERHEADNNEW A EN E
I NOTE1 • -
[ SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF %• ALDEN W YOUNG,PROFESSIONAL ENGINEER
SUFFOLK COUNTY ON DEC.27, 1985 AS FILE NO. 8037 , ,.. AND LAND SURVEYOR N YS LICENSE NO.12845
'3. HOWARD W YOUNG, LAND SURVEYOR - '
NTE LOCATION OF WELL(W),SEPTIC TANK(ST)N CESSPOOLS(CP)SHOWN HEREON NYS LICENSE NO 45893 • - -
ARE FROM FIELD OMSER'ATIONS MOON DATA OBTAINED FROM O:HERS - -
BRANDIS&SONS INC.1046- - - - - ,