HomeMy WebLinkAboutWitzke SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4452-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner STEVEN J WITZKE
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Mailing Address 1 280 LAUREL AVENUE
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Mailing Address 2
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City St Zip SOUTHOLD NY 11971-0000
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Property Address 1 280 LAUREL AVENUE
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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. 631-876-5208
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Tax Map No. section 56.00 block 3 lot 3.000
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Cross Street ROUTE 25
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Issue Date: 1/25/13Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
�OSUFFO�,��0
ELIZABETH A. NEVILLE y� Town Hall, 53095 Main Road
TOWN CLERK H Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS OSouthold, New York 11971
MARRIAGE OFFICER 'y • �� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ��l '1►aO Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10X__or Non-Residential @ $25 Application No. S 2
Permit No. 3591 23
Owner Name S _17.
Owner Mailing Address 2. g'0 L`�-�^i
Soc,Akoo Wl/ its-t1
Owner Property Address a So LG v-{'L
50u-0,00' Ny I/5-TI
Owner Telephone No. (;3)- 8-76- Sant
Tax Map No: Section 5 Block 0-,3 Lot 03
Cross Street Ro 4t, a�5-
Please check each that applies: New Construction K
Alteration to Exis1ng System
Residential�Non-Residential
NOTE: LOCATION MAP IIUST 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.)
9 21N 0I/0YIJ
Signature of Applicant Date
Received by:
.....ter.....:._,.. ,...;._ ,,. ..... ..... ._..:. ,,.:.�..._ �....__�e._..� .,.::.�..:_..._..._ _ ..: ...; ;.... {.
am familiar with the STANDARDS FOR APPROVAL
AND CONSTRUCTION OF SUBSURFACE SEWAGE S.C.D.H.S. REF. # R-10-09-0061
DISPOSAL SYSTEMS FOP SINGLE FAMILY RESIDENCES SURVEY SOUTHOLD
PROPERTY JAN 2 4 202
and will abide by the conditions set forth therein and on the g'1,50� a +4•2 Al SOUTHOLD
permit to construct. "E TOWN OF SOUTHOLD SUFF.CO.HEALTH ERVICES
N68 OFFICE OF WASTEW R MGT.
The location se wells and cesspools Shawn hereon are SUFFOLK COUNTY, N.Y.
from field observations and or from data obtained from others. Ln Z 1000-56-03-03
NTEST HALE DATA 15 9 ' '
2009
3 o SCALE. 1 =30
McDONALO ENCE MARCH 2, 2004 r
MA 1, 2009 � �` 00
Z p AUGUST 11, 2009 (B.O.H. &PROPOSED HOUSE)
EL 118' DARK aRow LDAu a w `° �+ (+i > SEPTEMBER 28, 2009 (REWSE0 SEPTIC SYSTEM)
f 4 BROWN aAY a RC''OVEwAv y �^, DECEMBER 20, 2010 (FOUNDATION LOC. & CERT7FICA77ONS)
If OCTOBER 17, 2011 (FINAL)
WA IVR 91 BROW SANDY aAY AND CLAY a Z D JANUARY 19, 2012 (RELOCATED DRIVEWAY)
0
� Y
9' r 4 22.5' 23. r, �Z.
WA IVR W BPOHN CLAY CH 0 C
u S
— J8' �� M►.�yy � 13.0' L
WATER W BROW RNE SAND SPZ eN`V, 9.0 v
y G7 r 22.5' u
u'
A m 4.1'
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30.3'
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00 CERTIFIED TO:
d 00 S0� STEVEN W1 TZKE
p 5 Sy9'Z 0 PQ G CIRI�77NA COMNGSSBANK !SADA
P�9 Fl ;- °15i AL TITLE INSURANCE COMPANY
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LOT COVERAGE
EXISTING (HOUSE, GARAGE,PA 770)
1,770 16,159 x 100=11.OY
PROPOSED (HOUSE, GARAGE)
2,121 / 16,159 x 100=13.130 E
Z. ''SS ,
o nf, rz°o.4 �� N.Y.S. LIC. NO. 49618
ANY AL7ERATION OR ADDITION TO THIS SURVEY IS A VIOLATION k11` R,s
OF SECTION 7209OF THE NEW YORK STA7E EDUCA77ON LAW. + � �LA,I.,,D ON/C YOBS, P.C.
EXCEPT AS PER SEC7IOV 7209-SUBDIVI5ION 2. ALL CER77F7CA77ONS 631) 765-5020 FAX (631) 765-1797
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF P.O. BOX 909
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF 7HE SURVEYOR F
159 SQ
, . T. 1230 TRAVELER STREET
WHOSE S7GNA7URE APPEARS HEREON. AREA=16SOUTHOLD, N.Y. 11971 04-116
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