HomeMy WebLinkAboutSabat ELIZABETH A. NEVILLE, MMC � � Town Hall, 53095 Main Road
P.O.Box 1179
TOWN CLERK �
Southold,New York 11971
REGISTRAR OF VITAL STATISTICSFax(631)765-6145
MARRIAGE OFFICER k �� ���� �° Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER �i 7 � www.southoldtowmy.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: April 22, 2019
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4750 for a Cesspool/Septic Tank
Construction Permit submitted by:
Carol J. Sabat
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 R0. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS t
� (631) 765-6145
MARRIAGE OFFICER
Telephone
RECORDS AGEMENT OFFICE q n.no 00
hfk. et
FREEDOM INFORMATION OFFICER2 sotolto rtoror
OFFICE OF THE TOW-N CLERK
TOWN OF L
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION I ALTERATION PERMIT
CESSPOOL I SEPTIC TANK
Residential 0.. or Non-ResidentialApplication o.
Permit No.
Applicant Name ..mm�.. � ,m
pp Ur__,CA_,k_
.....a
Applicant Mailing Address
Septic Tank or Cesspool
Brief Description of ro osecConstrtsel:ion or
� 4
Location of Proposed Construction/Alteration:
Owner of Property:ert ..mm._. .� � .........,..m. --
p :-
Owner Mailing Address
W
Property1desOwner .............m
�.._..JJL
Name and phone number of contact „_ OeOEF
ct person ......� 1
Tax Map No: Section
Block Lot
Cross Street �...��. _..... ....... ..
NO"r.E. LOCATION MAP musT BE SIJBMIT,rEDWITH AP.PL1CX..1°1ON. NEW
CONSTRUCTION REQUIRES S EIT: HEALTH DEPARTMENT APPROVAL
Al........
Si natore o f ' fico �l; este
as
Received by. .. m.,. -
TITLE NO. 8008-00591
y 44
pole
a`lkfA
n O
O 0 4_
p g.00
5 go 41 UNAUIHORIZEO ALTERATION OR AMMIERN
TO THIS SURVEY IS A VIOLATION OF
SECTION 7109 OF THE NEW YORK STATE
V 11 a n o EDUCATION LAW.
COIMES OF THIS SURVEY MAP NOT KANO
THE LAND SURVEYOR'S tWED SEAL OR
EMBOSSED SEAL SHALL NOT RE CONSMO
TO SE A VALID TRUE COPT.
GUARANTEES INDICATED HEREON SHALL XM
ONLY TO TILE PERSON FOR WHOM THE VJKW
LS PREPARED,AND ON HIS BEHALF TO THE
TITLE COMPANY,GOVERNMENTAL AGENCY AN%
LENDING INSTITUTION LISTED HEREON,AND
TO THE ASSIGNEES OF THE LENDING 114M
TUTIOH GUARANTEES ARE NOT TRANSFERAME
TO ADDITIONAL INSTITUTIONS Uk SUrS"411WE
OWNERS,
i
SURVEY FOR
EDNA TONNESEN
MATTITUCK 00HIE*-
TOWN OF S '
SU FF. CO., �
IT URANCE CO.
SCALE : I" = Q- SANK
NOTE: MAR. 17, 198 Y
a MONUMENT
y� N1 AND
N.Y. .LIC.NO.IZ646
N.Y.
NO. 80- 124