HomeMy WebLinkAboutGaydosik ELIZABETH A. NEVILLE,MMC um� an, Town Hall,53095 Main Road
P.O.Box 1179
TOWN CLERK Southold,New York 11971
AL STATISTICS Fax 631 765-6145
REGISTRAR OF VITAL , ( )
MARRIAGE OFFICER Telephone Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICERu
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Southold Town Clerk's Office
DATED: April 10, 2019
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4747 for a Cesspool/Septic Tank Construction
Permit submitted by:
Jasmine O'Keefe Cedar Knolls Inc. for Michael & Maria Ga dosik
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me. Thank you.
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE .._�.
DISAPPROVE
Comments: _. ........ ........... - .
Signature
Dated
ELIZABETH A.NEVILLE Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 /"or Non-Residential @$25 Application No. 1-411-4 -7
P 't No.
Applicant Name
Applicant Mailing Address,—
.. ......... .......
Septic Tank or Cesspool
—
sc. t c I en tion, ..........
Brief liptionofPro ose 'Orls tioll OZZ" t
Location of Proposed Constr tioAn/ lter, tion:
Owner of Pr
Owner Mailing Address:
_ , ., � - ..
Owner Property Address:,—
Name and phone number of contact person
Tax Map No: Section— JY—Block Lot
Cross Street
....................
NOTE: LOCATION MAP MUST BE SIJ,B,, I D TH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY W'IT ' E aPMENT JAP' lk? AL
Signatu7r 'of Appliedrit at
Received by: .. ........
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Septic tank
A-1 ;xsr_A
loachin3 pool
Future pool
Dry Well
a
Distribution box outlets shahbe equipped vifth
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end cap tip e le,elljrg nvices, a-Fie 9 In thn SCHD
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Note 2
Clean-out detail in accordance with SCHD standards Fig 9
dote 3
Lot will be coeaad to water and electricity soMcez;only KES
REV _Z Pc-,\/i5E1b PLAN Si!NtE 70 o-1,
poi to b"i[,_l Liu,-C,J,�,M home ail ypo Cal a SCHD
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z 31jrvey:RVan TuyI 12101175.Local 20ft
Ff-ac! "V41''2c,1L`!LJ 15-2 Lot size aq ft r_),,4 C, 7,
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OF NEW,0 5'(VM PL.4 5c TM iftl 000-?S 07 b4T
D 1n ba�,B, a nilzi 2 n-,h/P3, Bq Robert Barratt PE,4295 VarstRead,Cutchogue,Tel 631 734 2730
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The-plans design professional whose seaare an instrument!f the a,,-and a,e the property rf th-
I I;c,,,h P�ids�200 capa-111Y is ffi.rd ht.Irhingernarits will be
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prosecuted to the fullest extent of the a,Contract., h.11 verify all field
...........
S conditions and dimensions and ki solely resporstble for field fit.Th.
a'",-,,�-�,�r , design professional..edT-no liability to,..bsi..s due tounknown
orb.ri III
wii; sa-,�-J cy,!I a a, X fli"
_11, APLA, LOT AT E;LE -AO aid conditions and or arldnicn-is based upon comments o
C�sap��J I Sn acknowledged as plans