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ELIZABETH A.NEVILLE 1���h�0 yd Town Hall, 53095 Main Road
TOWN CLERK % d - P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS Al i Southold, New York 11971
MARRIAGE OFFICER Gy � ���, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER "'/Ql ���' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
: 1iii southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3038 R Residential x Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : EVA & RICHARD DRAEGER
Address 1: PO BOX 355
City St Zip EAST ROCKAWAY NY 11518
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 #R10-03-0007
Name Of Owner DRAEGER, EVA & RICHARD
Mailing Address 1 PO BOX 355
City St Zip EAST ROCKAWAY NY 11518
Property Address 1 2045 CENTRAL DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 106.00 block 2 lot 36.000
Cross Street LINDA ROAD
Building Permit Number Cross Reference:
Issue Date: 6/11/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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-Ne / 303Y
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ELIZABETH A.NEVILLE ; i' * % Town Hall,53095 Main Road
TOWN CLERK % ® - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % V 1,i Southold,New York 11971
MARRIAGE OFFICER ` y �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ;,_"mol �a®'ii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ���l southoldtown.northfork.net
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\ , ,, \\OFFICE OF THE TOWN CLERK
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H . 1,AY ' 2. 200 1'= , TOWN OF SOUTHOLD
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T(` �c I--�-Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 9, 2003
Transmitted herewith is a copy of application No. 3162 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Eva & Richard Draeger
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.
* * * * * * * * * * * *
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. CTS .6.47
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Signature
Dated
_
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OFFICE OF THE TOWN CLERK
Qt�/►_
TOWN OF SOUTHOLD �' Qj- Application No.3 /
ELIZABETH A NEVILLE,TOWN CLERKO v�1.
P.O.BOX 1179
Construction
SOUTHOLD,NEW YORK 11971 _ _
C •
cn 1 Alteration
Telephone II��� $10.00 -Residential
(516) 765-1801 _ O4/tO ��0� ,
1 $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE Q 4_0® 3
APPLICANT NAME: /
APPLICANT ADDRESS: ,A,a 3,S-S—
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, S/ ,, ��/►_� L A l
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/(JG w S/A( GL E L( 4) CC}C CLQ Ale-
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERAT/I�ON�:�
OWNER OF PROPERTY: c-P_ X4'4
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OWNER MAILING ADDRESS: /O. A 'c
,Jew 'i/ its p
OWNER PROPERTY ADDRESS: g� re
mg7-17rcY /&FS-2-
TELEPHONE NUMBER OF CONTACT PERSON: 5/4, --8- 99--o 4 3
TAX MAP NO. : Section 166 Block 02, Lot /7,11 . \-.9`)
CROSS STREET: pompe
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signaturef6 Applicant
RECEIVED BY:
own Clerk's Office
DATE: C Q �
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.-` EXCAVATION ,INSPECTION REQUIREFLED JAN i SW BEND 1172
3/I, ' FDR SANITARY SYSTEM A T/VIA TTITUCK INLET
BY HEALTH DEPARTMENT
• ` •} TOWN OF SOUTHOLD
• • SUFFOLK COUNTY, N Y
1000 - 106 - 02 - 3.6
Scale: 1" = 20'
-AEA =,12;000-sq ft . Jan. 8,2003
The locations-of wells and cess ools SliFF.._Kr Y t ~;: -,:,E i�z TMEJF 01 -TE AL•T'F SERVICES 4 ICES .
�lim hereon are from field observatiof►s I
dnd•- or from data obtained from others. • pµb'N/ r n f2V Lc � Y T^�Ti ' ON A
$del J � ,l'O�,}A..:?r ]7i t,.O�`:.1FAMIL(Lj"i 5'f6' C..:O3e
222S
ONLY '
ELEVATIONS ARE REFERENCED ., y .�. B
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TO, AN ASSUMED DATUM,. ILL-IL,. p -4b3-0 oa�3 = prop elevateon - 3-; iit� 4r1 ii! ;4rr' .. . .-. .J' I,om familiar -with the STANDARDS FOR APPROVAL FOR-M�tXIMUMC3�a' BEDROOMSlAND CONSTRUCTION OF SUBSURFACE SEWAGE ,DISPOSAL SYSTEMS FOR SINGLE FAMIL Y RESIDENCE I• :S THREE YEAR'`ROMDATEOrAPPROVAL
and will bide by the conditions set forth therein and on th
per'rni! /o canis"lracl: P��.p� NE�r ~
S�>o4,0 f. MErj O4
F
ANY SECTION
OR ADDITION TO THIS SURVEY IS A VIOLATION "
OF SECTION 7209.0 THE NEW YORK STATE EDUCATION LAW. /' '� "i s it
EXCEPT AS-PE 7209 • SUBDIVISION 2 ALL CERTIFICATIONS ( IN C',. t:1• .Y. •. UC. NO. 49b/8
HEREON ARE VAL 1,•FOR -THIS'MAP_AND•COPIES'THEREOF ONLY IF (s I, ' til, o ��;-
$AIO.MAP OR COPIES BEAR 'THE IMPRESSED SEAL' OF THE SURVEYOR ..y ;_".`
WHOSE SIGNATURE APPEARS HEREON. - e' '' • - `.C.
• ADDITIONALL.Y•,TO.COMPLY WITH SAID. LAW TERM 'ALTERED BY ' ;f6 :� i . (631) 765 - I7`97
MUST BE USED.,C Y•.A7�I,Y AND ALL,SURVEYORS UT1L-120(0:A COPY P. 0• - o `1-t
- cif ANOTHER SURVEYOR'S MAP.' TERMS SUCH 'INSPECTED't•AND 1230 - , V.� " STREET �t
'B uGHT- TO - DATE "ARE NOr IN COMPLIANCE WI7-"H THE LAW, SOUTHOLD, N.Y. 11971 ', • •
, i 402-I 5 F