HomeMy WebLinkAboutLeaden SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4367-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner GARY LAUBE, CHRISTOPHE LEADEN
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Mailing Address 1 310 ACKERLY POND LANE
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Mailing Address 2
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City St Zip SOUTHOLD NY 11971-0000
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Property Address 1 575 ACKERLY POND LANE
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Property Address 2
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City St Zip SOUTHOLD NY 11971-0000
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Owner Telephone No. 631-765-6105
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Tax Map No. section 69.00 block 5 lot 1.000
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Cross Street MAIN ROAD
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Issue Date: 1/30/08 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
o�g11FF0�,�c
ELIZABETH A.NEVILLE Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
y = Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS y. Ati
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER O'� �a southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 d or Non-Residential @ $25 Application No. V3(,
Permit No. n
Owner Name C�Y Lew 0 t*[f'Top/f2'/? /Y/ • Lc D �
Owner Mailing Address 3/v k e-W Z_A-.,V 6-r
Owner Property Address 5- -7-6- fit:K cgtc y 1 d/V-O L_4-Al cr
S`o 1to LD
Owner Telephone No. 76 S--6-/057 -7
Tax Map No: Section 6 4:0 ° Block S Lot /0 - 00 -0
Cross Street_ _ ^1171� R D
Please check each that applies: New Construction t�
Alteration to Existing System
Residential ✓ Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submit copy of survey with SCHD approval.)
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Signature of Applicant ate
Received by: / U 7
i I s
1� JAN 10 SURVEY OF PROPERTY
SITUATE AT
-- SOUTHOLD
TOWN OF SOUTHOLD
MAW SUFFOLK COUNTY, NEW YORK
unuTM Pom --� S.C. TAX No. 1000-69-05-10
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_..—. —••--� ROAD SCALE 1"=30'
ACKERLY POND MARCH a, Zoos
APRIL 19, 2006 ADDED PROPOSED HOUSE
(BOprERY j,ANE) AUGUST 26, 2006 FOUNDATION LOCATION
35 66.00' SEPTEMBER 25, 2007 FINAL SURVEY
00 �OF PAvo�xr' " E
N 8 AREA = 11,048 sq. ff.
0.254 ac.
CERTIFIED TO:
STONE WALL NONCOMMONWEALTH LAND TITLE INSURANCE COMPANY
0014C. 227't 'T IGARY LAUBE
1 1 1 /�.,,
a'�c� %F7�ER– 1 N "moi
1 1 NOTE
1
N 1. ZONING USE DISTRICT: AC (AGRICULTURAL CONSERVATION)
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1 CO 1
1 I O •
I 1 1 GI1F
o WELL & SEPTIC SYSTEM TIE DISTANCES
o\o\ s 1 1 J0p 1O 1 o COVER HOUSE CORNER"A" HOUSE CORNER" HOUSE CORNER"C" HOUSE CORNER"D"I
' m \o SEPTIC TANK
\� 1 1?hg �� o OUTLET COVER 30 33'
0
w
CESSPOOL COVER 1 30' 25'
$ Y CV c i
I 187 8 - CESSPOOL COVER 2 45' 42'
--- ��
8 Sao WELL 32.5' 68.5'
1
I O 1 rT &
1
UNAUTHORIZED ALTERATION OR ADDITION
-
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I ! 4 � TO THIS SURVEY IS A VIOLATION OF
��ON LA OF THE NEW YORK STATE
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n _ Nov „ W.
COPIES OF THIS SURVEY MAP NOT BEARING
�1j11U rr � 7� ' THE LAND SURVEYOR'S INKED SEAL OR
EMBOSSED SE SFWlNOT BE CONSIDERED
ONLY
CERTIFICATIONS
HES (NDICATED HEREON PERSON FOR WHOM THE SURVEY
RUN
SURVEY
1
y / li ON BEHALF
l ITITLPE COMPANY, GOVEER HIS
N ENTAL AGENCY RAND
i O o O { LENDING INSTITUTION LISTED HEREON, AND
TO THE ASSIGNEES OF THE LENDING INSTI-
IO\�� TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE.
THE EXISTENCE OF RIGHTS OF WAY
-.-..... »,.,. AND/OR EASEMENTS OF RECORD, IF
I 01 ANY, NOT SHOWN ARE NOT GUARANTEED.
I ZI CO
' I N PREPARED IN ACCORDANCE WITH THE MINIMUM
STANDARDS FOR TITLE SURVEYS AS ESTABLISHED Nathan Taft Corwin III
l7 BY THE LIAL_S. AND APPROVED AND ADOPTED
I FOR SUCH USE BY THE NEW YORK STATE LAND
TITLE ASSOCIATION.
°3s,z,° � ��oF NEW Land Surveyor
N X49 0p',DoW a.°s, g�P PFT C
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C�UD4' C4J?ZSOA, �'ZP Title Surveys – Subdivisions – Site Plans – Construction Layout
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PHONE (631)727-2090 Fax (631)727-1727
OMCES LOCATED AT MAILING ADDRESS
322 Roanoke Avenue P.O. Box 1931
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