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ELIZABETH A. NEVILLE �1/4 %*"'d Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
W3 ft
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER Fax
451, v� �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER 0l Aff, ��®�i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
SOUTHOLD ENAT TRLSpTSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2686 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
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 SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-01-0215
Name Of Owner CILEN, RIFAT & OTHERS
Mailing Address 1 1010 NORTHERN BLVD
SUITE 208.
City St Zip GREAT NECK NY 11021
Property Address 1 1250 ALBO DRIVE
City St Zip LAUREL NY 11948
Tax Map No. section 126.00 block 3 lot 8.000
Cross Street WELLS ROAD
Building Permit Number Cross Reference:
Issue Date: 11/01/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
6
ELIZABETH A.NEVILLEt$ ® -# •` Town Hall, 53095 Main Road
TOWN CLERK = P.O. Box 1179
REGISTRAR OF VITAL STATISTICS e �� Southold, New York 11971
MARRIAGE OFFICER Fax.,, ��� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER '�L% ,,�22,, �� �� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `�r ����
///�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 31, 2001
Transmitted herewith is a copy of application No. 2779 for a Cesspool/Septic Tank Construction
Permit submitted by:
Theodore Martz,Jr.
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:
Signature
id a� ��
Dated
Je • ,y!' -
.*
•t
OFFICE OF THE TOWN CLERK �'•' ��CF0L '
TOWN OF SOUTHOLD ;•'OO� `�G_; ' Application N .2 7,
ELIZABETH A.NEVI LE,TOWN CLERK
P.O.BOX 1179 ' : Construction
SOUTHOLD,NEW YORK 11971 v T
Alteration
Telephone ‘g°0O�'.:
• $10.00 -Residential 7<..
(631) 765-1800 =- �1. $25.00 -Non-Residential
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
for
gPeei ! ED
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL OCT 3 i 20W
..n®fi° lov/n Clerk
Permit No.
Fee .$
DA E 10 �OOt
APPLICANT NAME: ( po '
APPLICANT ADDRESS: IL � I' 43en,kke.
AlAncoRo 11(e PLi t (q, bci
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED C STRUC�`ION OR ALTERATION
OWNER OF PROPERTY: t (-,1 -I-• S C b 64414440 e .
OWNER MAILING ADDRESS: lo10 'eteN. C ‘C, f• Sue,K �
'ham 110)-1
OWNER PROPERTY ADDRESS: 12.x$0 4 st,
V19�
4t. •4.....‘I
TELEPHONE NUMBER OF CONTACT PERSON: (Cs. 1 -• 12:18 Q '
TAX MAP NO. : Section 0.10 Block 03 Lot C8
•
CROSS STREET: ISI
BUILDING PERMIT NUMBER CROSS REFERENCE:
• 1,.,4?*, , i
, ''' 0 Signature of A. •lica ,W
RECEIVED BY�A
Town C erk's Office
DATE: \O .31 )61
S.C.T.M. NO. DISTRICT: 1000 SECTION: 126 BLOCK: 3 LOT(S):8
. .
11
LILO DWELLS
\ PUBLIC
W
A WATER
EL 33.9 4'1 j
CrO
EL 49 ' TO
9
DWELL
PUBLIC o • 41zPWATER • \
PS°vosto 36. 0 •
,,
" z
`p ; 33.5) G'
39.7` (33.5)
-L•
0) 0 i 7;\ .
z
25�. cle, y�� D.P.
O �i" \O BIM "
•°• �a.soni E
• 1,FFA' 37.0'
W CL 30.23
0 3.5) EL 29.9 f
•m 26. i (
Z PROPOSED WATER SERVICE �� ;
(33.5) - •
35.6' '
EL 33.2 \ %., b.
'
I)
ELEV. 33.9 N32'46'0011 EL 31.0 't '-
136.94' ic
SANDY LOAM . CL 29.97
DWELL '
PUBLIC
WATER
PALE
BROWN c LIL/6
co..,
FINE ..'
TO N
COARSE
SAND
SUFFOLK COUNTY DEPARTMENT OF1 SERVICES
NO WATER PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
SING . ,i1 .Y RESIDENCE ONLY
9-29-01 P -
n
D,� ® « I®1 : 4 a 0( .-- ).t5'
APPROVE:' M , THE WATER SUPPLY, WELLS AND CESSPOOL
— LI_ LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS
I'0I? Mil f? i u -' ')- . : coJ? '.ig AND OR DATA OBTAINED FROM OTHERS.
AREA: 17, 132 S,F, OR 0.39 ACRES;CHRET I„' .,I, , . '2►�(NV AL ELEVATION DATUM: ASSUMED
UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION.LAW. COPIES OF THIS SURVEY
MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION
LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE.
THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS
AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARAN TEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY
SURVEY OF: DESCRIBED PROPERTY • CERTIFIED TO: THEODORE C. MARTZ JR.
MAP OF: j_IZY '1:1I'Jir`LI3€='VI. 301.4.Ai
...M71,t, ,_1 I.1 -0i,.: _i :1) 1d n:,
FILED:
SITUATED AT: LAUREL ?” .L �� �� ��
TOWN OF: SOUTHOLD AD.N AD. in , j U J:'ii S KENNETH M. WOYCHUK L.S.
SUFFOLK 'COUNTY, NEW YORK A a)J bc/ , Land Surveying and Design
. (1,.....thi M. v% Cil P.O. Box 3, Mattituck, New York, 11952
.. 298-1588
FILE # 21-1 92 SCALE: 1 —3Q DATE: OCT. 1 2001 PHONE631 29 —( ) 8 1588 FAX (631)
N. Y. S. UC NO. 50227 maintaining the records of Robert J. Hennessy