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ELIZABETH A.NEVILLE 1i=moo O# Town Hall, 53095 Main Road•
TOWN CLERK o P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS rr1 i Southold, New York 11971
MARRIAGE OFFICER 4, �����, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � ®1 jig 4;0����0 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER 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. 3052 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : THEODORE 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 #R10-02-0202
Name Of Owner DELFINO, VERONICA
Mailing Address 1 21 PARK AVENUE
City St Zip WHITE PLAINS NY 10603
Property Address 1 55 7TH STREET
City St Zip LAUREL NY 11948
Tax Map No. section 126.00 block 1 lot 18.000
Cross Street BRAY AVENUE
Building Permit Number Cross Reference:
Issue Date: 6/11/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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I� SUFFOL4-c
. 3o 3Z_'ELIZABETH A.NEVILLE �_' O* Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
y Z Southold,New York 11971
REGISTRAR,OF VITAL STATISTICS
MARRIAGE OFFICER 1,i'L � �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER 6. jail a�ii• Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER .1 s" southoldtown.northfork.net
' OFFICE OF THE TOWN CLERK
IvjAY
2 8X11; TOWN OF SOUTHOLD
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TO:� Southold-Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 28, 2003
Transmitted herewith is a copy of application No. 3176 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
PPROVE-DISAPPROVE
Comments:
Gv -
�
Si ature .
Dated
;,,,...1/I/_
OFFICE OF THE TOWN CLERK ,l�'� NVgLK
TOWN OF SOUTHOLD ��.'��J CQG Application No. .y. f.
ELIZABETH A.NOME,TOWN CLERK i �1
P.O.BOX 1179 L ; Construction
SOUTHOLD,NEW YORK 11971 : a ' i
Alteration
sUI Telephone „�✓O 0-gb�'/,
• • $10.00 -Residential
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(631) 765-1800 ��1. �''� $25.00 -Non-Residential
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TOWN OF SOUTHOLD
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SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
•
for
CONSTRUCTION or ALTERATION PERMIT ,
SEPTIC TANK or CESSPOOL
Permit No. •
Fee $ •
06-12-61-2-00
(""‘ D TE /�
APPLICANT NAME: �'�G
APPLICANT ADDRESS: i -4 . r ". U.Q
• -' tddalle i \141. 'WI
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION
E, DCONSTR�UCTION ORATION
ert\, PeRe
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LOCATION MAP: Must be attached hereto before permit may be issued. .
LOCATION OF PROPOSED CONST CTION • ' • LTE TION:
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• . OWNER OF PROPERTY: l, v ('1•co
OWNER MAILING ADDRESS: ut____ eAlke_..
OWNER PROPERTY ADDRESS: 6--4 -I I riAr C--
TELEPHONE NUMBER OF CONTACT PERSON: 4 — 8- `4T
TAX MAP NO. : -Se tion 11' Block O Lot 18 •
CROSS STREET: JeiN
BUILDING PERMIT NUMBER CROSS REFERENCE: i �I
. OrP;/0,0P-Aw
./0 \.-.,--1. , lir-Au
Signature of Ap•. icant
RECEIVED BY: (605\41)(k •
Town Clerk's Office
DATE: 6k3o2 •
_ . T / DWELLING '
S.C.T.M. NO. DISTRICT: 1000 SECTIIW 126 BLOCK: 1 LOT(S): 18 W (PUBLIC WATER -•
/ \
/ — �—
RECEIVED
ELEV. 32.0 / � �\ SUFFOLK COUNTY
BROWN /1 \ HEALTH SERVICES
SANDY LOAM .
;�Y�STAND \ 2002 OCT 11 A II: 22
3.o VACANT
DWELLING
/BROWN LP W/WELL \ WELL
FINE I
To 100' , \ O
/ MEDIUM
SAN
/ / I • DWELLING
/
\�__- \ J - CL 25.14 W/WELL
- . - SEVENTH (25') ' STREET `
I NO WATER 17' CL 30.1 - C6.2` 15'
DIRT ROAD CL 28.2 \ CL 27.2 CL 25.9
ERj�EAD
09-06-02 WIRES - 0
\
I BY: McDONALD GEOSCIENCE EL 30.3 N69�13'10"E \ 0 / 1 0•00 EL 26.6OW� Z
o �,Z ou. Lu
3 _ IV Z
O EL 30.8 Np U.F. �J�'�CL 25.42
• POOL D_ 0 EL(32.D) EL 2-976.---7-4.06 Ir-IZ
LOT 27 EL 31.9�� 844 EL(32.0)
in S.T. �0 24.0' 40.0' I p wo
I MIN_ C7i 1— DWELLING
DWELLING411) 46.0' GARAGE I PROPOSED 0 W/WELL
W/PUBLIC WATER ., GF 32.5 2 STY. FRM Iii
I 100' p ':WELLING N 40.0 w
in LOT 28 19'N I W/CELLAR
1 \ 0� 1N EL 32.0 FFL 34.5 /PROPOSED WATER SERVICE— pj W
L 0
l E� EP � } � d-
PR o EL�2.0) aQ
VP\\-\\,S O /EL(32.0)
4' W E FE—x-=7.1'N O �"��
ZEL 32.2 (To BE REMOVED) N / O 'Qj Q
\ T
E29.9 ( EL 28.8 pCL 25.51
- - S69°13'10"W140.00' �¢
\ I LOT 29 DWELLING I I N DWELLING
X ASSUMED W/PUBxIC WATER I - W/WELL
AREA: 7,50�SQ.FT. OR 0.17 ACRES ELEVATION DATUM: _ � 5p' --..........—
UNAUTHORIZED
�
UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECRON 7209 OF THE NEW YORK STATE EDUCATION LAW COPIES OF THIS SURVEY 1 J
MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY GUARANTEES INDICATED HEREON SHALL RUN OR A
3 44"---.1..i.L�;CO jJjj ry DE��,1~'I'MEi4''f �1F HEALTH `
ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE RILE COMPANY GOVERNMENTAL AGENCY AND LENDING INSTITUTION t — — r
��
LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. I � � �Vpl��14��}'aJ' : , ��j,� Y'THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO RHE STRUCTURES ARE FORA SPECIFIC PURPOSE AND USE THEREFOR£ THEY ARE I / DWELLING I '':KI` �'-
NOT INTENDED TO MONUMENT ME PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS 'T
AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY ti W/WELL I c3 SINGLE FAMILY E"' '`•N `ONLY
IN FRONT YARD z
SURVEY OF: LOT 28 CERTIFIED TO: THEODORE MARTZ; 50' DAT .,.f -1-0 HS .- F. , 0. ,,, 0- e2-0 --or),�
MAP OF: GEORGE T. TUTHILL SEC.1
FILED: JAN. 15, 1929 DWELLING APPROVED
SITUATED AT: MATTITUCK W/PUBLIC WATER FOE`' AXIMUM OF I3 t a� s
TOWN OF:SOUTHOLD KENNETH M. WOYCHUK L.S. 3 I' 50' EXPIRES THREE YEARS FROM DATE OF APPROVAL
SUFFOLK COUNTY, NEW YORK and
r 4../
/� P.O. Box
Land 3,SuryMattitucingk. NewDesign York. 11952 F
PHONE (631) 296-1568 FAX 031) s9e-15e9 i LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS
AND OR DATA OBTAINED FROM OTHERS.
FILE # 22-138 SCALE 1".20' DATE:SEPT. 16, 2002 N. Y S. LSO NO 50227 melntamtrY the mord, of Robert.J. Henning S�
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