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HomeMy WebLinkAboutVan Mater (2) rR 4,r ,froN JUDITH T. TERRY � Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS C MARRIAGE OFFICER �''� Fax (516) 765-1823 4 Fax (516) 765-1801 _ ® -'," OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 787 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : ANNE-MARIE VAN MATER Address 1 : P. O. BOX 1231 City St Zip MONTAUK NY 11954 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 5/29/91 Name Of Owner VAN MATER, ROBERT & ANNE-MARIE Mailing Address 1 P. O. BOX 1231 City St Zip MONTAUK NY 11954 Property Address 1 "MOCKINGBIRD LANE -HIGHPOINT MEADOWS - LOT 48 City St Zip SOUTHOLD NY 11971 Tax Map No. section 55.00 block 6 lot 15.001 Cross Street TUTH I LL ROAD EXT. Building Permit Number Cross Reference: Issue Date: 12/17/91 Judith T. Terry Southold Town Clerk •r--nwhJ SiQi - -'~� ezf uurppt- JUDITH T. TERRY 04, Town Hall, 53095 Main Road • TOWN CLERKa P.O. Box 1179 REGISTRAR OF VITAL STATISTICS s, ' Southold, New York 11971 MARRIAGE OFFICER 4 Fax (516) 765-1823 __ , i�` Fax (516) 765-1801 OFFICE OF;THE TOWN CLERKDFrt-5-2— i--9hrlil TOWN OF SOUTHOLD il/To: Southold Town Code Enforcement Officer From: Linda Cooper, Southold Town Clerk's Office TOWN Oc, vFL"'` D Dated: December 4, 1991 Transmitted herewith is a copy of application No. 808 for a Cesspool/ Septic Tank Construction Permit submitted by: Robert and Anne-Marie Van Mater 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: plea oQ,,, cs.' cZtriatye .. Cr4...4. 'kir-0.4.mA LA). %.1•4..)1AD,L Asaidtik Nt• \CZ eY064.• Signature RSD ax..k .ziAct‘\ Dated DEC 171991 Toren Clerk Southold P„t •• OFFICE OF THE TOWN CLERK etc5 c���-FO(A'^'Town of Southold pn�Juith T. Terry, Town Clerk =�” i Application No.O Town Hall, 53095 Main Road o 1.�� - - cn tx'� , Construction P. O. Box 11793 = Southold, New York 11971 %, r e Alteration • Telephone 1 i !y� Residential v� (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 �Lfa-LkS%-(L \ C `1 � � /I APPLICANT NAME: Alr]WE--�`=�A�(.�`\/AO kik,k-k-TIL APPLI CANT ADDRESS: \?O ` bt,x �� } a"`o�T�lvi� Pe 119 6. SEPTIC >( CESSPOOL •X w t DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION_Nett} /1/4:)(156- LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: OWNER MAILING ADDRESS: C) `'2D©x \ a3\ j O �‘2, iv 1 H . • OWNER PROPERTY ADDRESS: AOC .Ilti�( 1iLl) 1,-NAL <)nrrl✓h0(-4) } )Y VA,t t_ PO - LOT TELEPHONE NUMBER OF CONTACT PERSON: cello- S-- L\-5,6-T (l3) TAX MAP NO. : Section ST Block L, Lot 610 /5. / CROSS STREET: _ �t=� R-�i I t7 1 F�6 LL. ' *A.CS 'BUILDING PERMIT NUMBER CROSS REFERENCE:. /' • Signature o Applicant • RECEIVED BY: RECth lerk's Office DATE: -�: 1 Town Clerk Southlid :Y • ,!, ' I . • I (VACANT) - WATER MAIN / od L=17146 \ . - / 43 'DVEi,� C.-. ` E�'z1.3 PZ. � NN / i,„. ....‘bbN. OA + i9 49 I yh°y6 v° ?) $ A� �ilL ,' IT DP L. s rep; 48 oo 2• 436 S.f, o G (��z �y / Ns903 ,quo, ' �O / ( 40 y7-0 9 nNr1 {, O • �2s� itgCZRYIE 1/4/.....„, •� ;'`!; APR 16 1a91 EALTHSERVOF 1. ES SURVEY FOR SUFFOI.I(COMNYY DEPARTMENT OF HEALTH SEJVICES ROBERT A. VAN MATER a ANNE-MARIE VAN MATER ' � LOT NO.48,"HIGHPOINT MEADOWS,SECTION THREE" FOR APPROVAL OF CONSTRUCTION OF ( - AT SOUTHOLD DATE NOV. Single Family Residence Only• ;'" ' a �2S-`I TOWN OF SOUTHOLD SCALE I'.=40 G� ,-- DATE' REF.NQS! �U a? SUFFOLK COUNTY, NEW YORK NO 90-C APPROVED reef • •UNAUTHORIZED ALTERATION OR ADDITIoN TO THIS CERTIFIED TO SURVEY e A VIOLATION OF SECTION 7209 OF THE ROBERT A V ER NEW YORK STATE EDUCATION LAW ANNE- WA* R EXPIRES TWO YEAR FROM DATE OOFAPPROVAL OVIES S THE SURVEY NOT BOSSED SHE LAND BRIG •. T A ,, SURVEYORS INKED SEAL OR VALID TED SEAL SMALL JJ�� -• _ -s. NOT 9E CONSIDERED TO LEA VALID SLUE COPi TICO T .t1.1.- -. L./ �— O I' •GU AEANTEES INDICATED HEREON SHALL RUN ONLY TO �P • ) THE PERSON FOR WHOM THE SURVEY IS PREPARED ® O DEPARTMENT-DATA FOR APPROWAL TO CONSTRUCT ANo aN HIS ISEHALF TO THE TITLE COMPANY,GOVERN- ,` ST WATER MAIN_MI I'SOURCE OF HATER PRIMTE_pU9.IC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED y. 0 TAX MAP 019T 1000-SEC TION Sy BLOCK_SL LOT D/015 I HEREON,AND TO THE •ASSIGNEES OF THE LENDING Asa{A;•^ ARE NO DW[LLIN99 WITHIN 100 FEET OF TNS PROPERTY INSTITUTION GUARANTEES ARE MOT TRANSFERABLE �t`�"J�YY/I it NAN THOSE SHOWN HEREON TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT ''' '�� - TER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOIL THIS RESIDENCE OWNERS ■DISTANCES SHOWN HEREON •SPECFROM TY LINES - PORN TO THE STAN OAIIOf OF THE SUFFOLK COUNTY DEPARTMENT TO EXISTING STRUCTURES U1[FOR •3P[CI FICJ M ICES PURPOSE AND ARE NOT TO BE USED TO ESTABLISH C4 5 T.1/_' � A JU A 1C vAu�A� _ PROPERTY LINES OR FOR THE ERECTION OF FENCES •;TF`pp SUR, %O "` Ib �� •RYOUNG a YOUNG qs ",� =STAKE ALDEN W YOUNG,PROFESSIONAL ENGINEER SION MAP FILED IN THE OFFICE OF THE CLERK OF AND LAND SURVEYOR N Y.S LICENSE NO 12845 ' COUNTY ON MARCH 19,1990 AS FILE NO.8912. • HOWARD W YOUNG, LAND SURVEYOR • OF WELLIW),SEPTIC TANK(TTTI CESSPOOLS(CP)SHOWN HEREON NYS LICENSE NO 45893 ELD OEATIONS AND OR DATA OBTAINED FROM OTHERS (! pRH SONS INC