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ELIZABETH A.NEVILLE / � Gy Town Hall, 53095 Main Road
TOWN CLERK ` H P.O.Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER ‘4*
y / Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER '.. O,j i Fax
(631) 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. 2491 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ANDREAS MICHAEL
Address 1 : 7-20 CLINTONVILLE STREET
City St Zip WHITESTONE NY 11357
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF # R10-00-0259
Name Of Owner MICHAEL, ANDREAS
Mailing Address 1 7-20 CLINTONVILLE STREET
City St Zip WHITESTONE NY 11357
Property Address 1 5755 WESTPHALIA ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 113.00 block 12 lot 3.000
” Cross Street COX NECK ROAD
Building Permit Number Cross Reference:
Issue Date: 1/10/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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•
ELIZABETH A. NEVILLE ��_• Gy< ` Town Hall, 53095 Main Road
TOWN CLERK ; y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS '� Southold, New York 11971
MARRIAGE OFFICER s` y . / Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �_ �d **I"
,•. Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ .9'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: January 2, 2001
Transmitted herewith is a copy of application No. 2579 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Andreas Michael
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.
Linda J. Cooper
* * * * * * * * * * * *
I have,reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings, property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
ignature
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Dated
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OFFIeEE OF THE TOWN CLERK ot° VULk/n�'
TOWN OF SOUTHOLD ���, � • `(V Application No.p2,S/ ,1
ELIZABETH A TILE,TOWN CLERK �� y� C/
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 v13/471
3/4 �. Alteration
Telephone 0,� �417�'�, $10.00 - Residential
(516) 765-1801
et l,�,�" $25.00 -Non-Residential
• .,�� ,i
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Permit No.
Fee $
DATE Vg:2/00
APPLICANT NAME: A na cs MI c auJ
APPLICANT ADDRESS: 7.- v! /� j-fte f
76-,g1-79�2e_/ GU /73c57
SEPTIC CESSPOOL
DESCRIPTION/} OF PROPOSED CONSTRUCTION OR ALTERATION
PEW 01)E b.-4,1111y amu/FLL-/A-2i . TyP6- r/1F C®l-saT141eT>v#) .
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Avdr ej, M I j/Lt 61
OWNER MAILING ADDRESS: G e- c, -O C_1(0?L7p l/fife- g717,-•ee
jJi/ 743 7
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OWNER PROPERTY ADDRESS: 57- 5
• bal/a £ c,Jo
A1104J--j -/-iicIL , tAY //952
TELEPHONE NUMBER OF CONTACT PERSON: (7/f) 7i 7r-,5'27s -
TAX MAP NO. : Section //3 Block /2 Lot 2 co 3
CROSS STREET: (Q)( 4A-4, 40a4
BUILDINGPERMIT NUMBER CROSS REFERENCE:
Signature oficant
9pp
RECEIVED BY : %-/i/()
T n Clerk's Office
DATE: O6
4,
v
TEST BORING DATA SCDHS STAMP
0' ----
TOPSOIL
l, SUFFOLK COO.?Iii'DEPARTMENT OF HEALTH SERVICES
SANDY BROWN LOAM PER'VIIT .1 R APPROVAL OF CONSTRUCTION FOR A
a,IGLE FAMILY RESIDENCE ONLY
3 DATE. M-l$P° HS REF.NO. 60-CC-02S3
APPROVED
SAND MIN MEDIUM TO ____ L6IZti�nr.0 .
COARSE GRAVEL
FOR MAXIMUM OF 1^( BED 1; S
EXPIRES THREE YEARS FROM DATE OF APPROVAL
/7'
SCALE 1"=30'
10070 WES TPHA L/A ROAD
_ 10035
W WAIL-AMAIN µ'
10004
EDGE OF P yyT —w
10017
100 00
100 36
500 23 MON 1$0' N7774'00'E-
rte FOUND 131.00' 7N
2 STK 102.06
SET
C 3
W
3 � _ X10. 0 1
100 73 R 101 05
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70149 N ri-41' K
e E K_ I 42 O' 101.06 ti , -
3 0 230' y Q
O v PROPOSED 100 42 W 3
m o f BEDROOM V
y N DWELLING h
O FFL £L=1030 y
£ 23 0' 73 8'
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2 p I28 2' pn pW p
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po (o p p ON°jN I:
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1.-Q,_ * 10096 (O
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SETBACK LINE 7YP
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1036 '' 10218 rte:
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10514 PIN 131.00'
S7X I i.�
FOUND SET _ --j-:<-;fr-,
57724 OO"W 10413 r..
CJ
PARCEL/MPROVED AND T
SERVED WITH PUBLIC WA TER ULuwhonxd altemron or admhon to a survey
,nut o,ul testa,1200 sueownnns snl a 4
New
Ine 011 Stale
tI I[Su�' 'Ohl 0espis
0 o nal oI lRe land:mreroTs moossed seal
shall be considered to be saIE Sue copes"
'CendicaOonS Inflated hereon signify that Irks
survey was prepared in nce with the
costing Code of practicea In,for Land surreys
ProfessiONl Land Sury ort State Aisocalion of
eyors
MAP OF PROPERTY
SITUATED AT CONSTANCE PILNACEK, PLS
MA TTI TUCK, TOWN OF SOUTHOLD PO BOX 53
SUFFOLK COUNTY, NEW YORK ST. JAMES, NY 11780
CER77FIED TO. (631) 862-1111
ANDREAS MICHAEL N.YS. L/C NO. 50163
MARY MICHAEL
FIDELITY NATIONAL TITLE INS. CO DATE 5/8/00
STG ASSOCIATED, INC REF. NO. 00-655
77TLE NO. S20-00888
TAX MAP DESIGNATION DISTRICT 1000 SECTION 113 BLOCK 12 LOT 003