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HomeMy WebLinkAboutVan Bourgondien JUDITH T. TERRY Town Hall, 53095 Main Road TOWN CLERK ® % P.O. Box 1179 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS r �' Fax (516) 765-1823 MARRIAGE OFFICER d' oa l�� Telephone (516) 765-1801 RECORDS FREEDOM OF INFORMATION ON OF ICER =�® FAGEMENT OFFICER il OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1080 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : THEODORE C. MARTZ JR. Address 1 : 145 RYERSON AVENUE City St Zip MANORVILLE NY 11949 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. #92-SO-97 Name Of Owner VAN BOURGONDIEN, MARK & KAREN Mailing Address 1 1950 BOISSEAU AVENUE City St Zip SOUTHOLD NY 11971 Property Address 1 GRANGE AVENUE City St Zip SOUTHOLD NY 11971 Tax Map No. section 0 block 4 lot 12.000 Cross Street BAYVIEW ROAD Building Permit Number Cross Reference: Issue Date: 12/23/93 Judith T. Terry Southold Town Clerk (TOWN SFAI - - f i 0° 7° eFID 0 ® fid' JUDITH T. TERRYTown Hall, 53095 Main Road TOWN CLERK ® . 0-ri ,, P.O. Box 1179 VD w ; Southold, New York 11971 REGISTRAR OF VITAL STATISTICS V \- Fax Fax (516) 765-1823 MARRIAGE OFFICER = �` ,i4)��t Telephone (516) 765-1801 RECORDS MANAGEMENT OFFICER `--•••••....../.."01's 77Q� 0 FREEDOM OF INFORMATION OFFICER -••���. id�i's00, OFFICE OF THE TOWN CLERK ! g 1-7. ,,=''- ,L TOWN OF SOUTHOLD Va .7� ,¢ yf TO: Southold Town Building Department SLCA1.Dc.e : � TOWN OF SOUTHOLD _. FROM: Linda J. Cooper, Southold Town Clerk's Office — DATED: December 15, 1993 Transmitted herewith is a copy of application No. 1115 for a Cesspool/ Septic Tank Construction Permit submitted by: Theodore C. Martz Jr. for Mark and Karen Van Bourgonclien 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: Vq5-1f,". c5- 9 "--'5°- 7 R.F,AND- , —,•.r., di eiee, PFC2.2 IOW Signature ' 1,111m7, ragSOUibO! Dated i .. • OFFICE OF THE TOWN CLERK ':^: ' • • Town of Southold Judith T. Terry, Town Cleric ' rr -�'; ���.. v /I/c Town Half, 53095 Main Road '" ��� Application No c �',' moi... ,. P. O. Box 1179 cn il;t, Ft:- ' r/ConstructionSouthold, New York 11971O:' "�' :.' -C;-: �- Alteration , Telephone �l i yb t� (516) 765- 1301 Residential Non-Residential • TOWN OF SOUTHOLD . SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION • far • • CONSTRUCTION or ALTERATION PEP,1L11TI SEPTIC TANK or CESSPOOL - Permit No. Fee $ • DATE /Z IS �_ • .. APPLICANT NAME: i ::\keopee,g C A,/ArrWf—"--- • APPLICANT ADDRESS: i 4- - • eR '. - ii1 geJ 1 `I✓ 1 1 vq•eq • SEPTIC CESSPOOL - DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION - <-_____R•• ' i-': • • LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONST I•UCTION R AL ER OWNER OF PROPERTY: J� TION; , • • OWNER MAILING ADDRESS: • 1ti �� , 1 .! ilei OWNER PROPERTY ADDRESS: Cis r e I . . < d • • TELEPHONE NUMBER OF CONTACT PERSON: g98 — e �� T`t'� TAX MAP NO. : Section BI ck © - � Lot f7 . CROSS STREET: - .S Jia OAD BUILDING PERMIT NUMBER CROSS REFERENCE: • • • Ct • Signature of I I RECEIVED BY: �D /� , pp �c�n Town/Clerk s Office DATE: .__"10 91 .9 19 2 58 Qt, g2 I now or formerly • _N Church Of The Open Door .___.FI____ N85°3540 E 7830 - _ EL.292 EL•289 Z .D. Lot IO , 0 N A - _---____ Lot 9 0 DWELLING Area = 21448 sf o , (W/PUBLIC WATER) m f _ 0 0 N 85°3550flE. O Lot 8 ' 16 70 °- • I V"EL•2B 8 - - III 40 S0 C) -_ RIGHT OF WAY Z 40' 11D �� :Z7 v°ey 1 ' PROPOSED 1 T› ° OR1VEu�AY \�I I Z. PROPOSED . Lot I I - ° WATERS6,TVKf No O`LO CNT 1"1 HOItSE I l0 m IV ' (VACANT) C40' 35' __Lr----1\ , m f', \ pROPO` D - 1 N O gpN RART 1 1ST ys. o - Ewa z 1 m 0°tip ' a T 1 F 1 / ' ,Ld- O .29t f • - , c /-- X21 v 3 m . 91 °�2O Lot 12 ' ZII E.' ) 5O_. P • (VACANT) O , z ) 1 L *.,..'Leb , V V 90 \�I GAP-- �3 VON SINGLEFAe•RILY DW IMG ONLY ,.,.,‘,,",..6,,-9.\EXPIRES- YEARS FR M DATE OFAPPROV °. ' SURVEY FOR SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICE? VAN BOURGONDIEN Q KAREN M. VAN BOURGONDIEN PART OF LOT 9 ,"SOUTH HARBOR HOMES" FOR APPROVAL OF CONSTRUCTION ONLY AT SOUTHOLD DATE OCT 2, 1992 TOWN OF SOUTHOLD SCALE I "= 40' OATEN 1 7 992 REF. NO. sigib1 SUFFOLK COUNTY,, NEW YORK NO. 92-0852 In *UNAUTHORIZED ALTERATION OR ADDITION TO THIS CERTIFIED TO ' �'l% SURVEY IS A VIOLATION OF SECTION 7209 OF THE �- MARK VAN BOURGONDIEN APPROVED NEW YORK STATE EDUCATION LAW KAREN PA VAN BOURGONDIEN *COPIES OF THIS SURVEY NOT BEARING THE LAND URVEYOR•S INKED SEAL OR EMBOSSED SEAL SHALL FIRST AMEI)CAN',T E.JNSURANCE NOT-ISE CONSIDERED TO BE A VALID TRUE COPY L COMPANY YZ)HiL THE PERRGu NSONES FOR WHOMED HEREON THE SURVEY'ISLRuN PREPARED LY 10 - ,u"^�P(,U oV.jroUo4"®® HEALTH DEPARTMENT-0 FOR APPRO • TO CONSTRUCT � �-.��. - AND CH HIS BEHALF TO THE TITLE COMPANY,GOVERN- i Cfy 0 I.� O --� M NEAREST WATER MAIN MI • SOURTE-OF-WA ER,PRIIATE_PUBLIC AL MENTAL AGENCY AND LENDING INSTITUTION LISTED 8� ill N SUFE CO TAX MAP 01 1000o „ SECTION BLOCK 44_LOT 012 HEREON,AND THE ASSIGNEES THE LENDING _ ^^^ "`]]] *THERE ARE NO OW LLINSS (THIN 100 FEET OF THIS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE �� ' OTHER THAN THOS SH. N ON TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT '6i M THE WATER SU. Y •SEWN DIS/OSA SY EM FOR THIS RESIDENCE OWNERS ! " air pt CONFORM STA *DISTANCES SHOWN HEREON FROM PROPERTY LINES 115 •".� OF T S OLK COUNTY DEP 7 TO EXISTING STRUCTURES ARE FOR A SPECIFIC :..-7. "Qd",5 u, W OF HEALTH lE1tV I- / 'R�y,�,rj�-1 APPLICANT. / //�%/'✓ PURPOSE ANO ARE NOT TO BE USED TO ESTABLISH _ 'ipT,�,1AtYD,� ,•r i/ `� /AZT PROPERTY LINES OR FOR THE ERECTION OF FENCES 1anlatts,.(" ADORES 27 , TEL ', YOUNG a YOUNG R�IVOERFIEADNNEW YORK NOTE• •=MONUMENT 6,0••STAKE - tr I, SUBDIVISION MAP FILED IN THE-OFFICE OF THE CLERK OFr- ALDEN W YOUNG,PROFESSIONAL ENGINEER SUFFOL K CO.ON JULY 14,1964 AS FILE NO.4096 AND LAND SURVEYOR N Y.S LICENSE NO 12845 E. y HOWARD W.YOUNG, LAND SURVEYOR • , *THE LOCATION OF WELL(W),SEPTIC TANKIST)B CESSPOOLS(CP)SWANN NEREON N Y.S LICENSE NO 45893 ` AND ARE FROM FIELD OSSERVATIONS OR DATA OITMNED FROM OTHERS - • BRANDIS&SONS INC. 1046 - '