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ELIZABETH A.NEVILLE,MAIC 4,v, Town Hall,53095 Main Road
TOWN CLERK
v* P.O.Box 1179
4
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631)765-6145
MARRIAGE OFFICER - Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER �_� -" www.southoldtownny.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: May 3,2019
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4752 for a Cesspool/Septic Tank Construction
Permit submitted by:
Thomas M.Ludlow for David Schultz.
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: Final approval required from the Suffolk County Health Department
Signature
Dated
ELIZABETH A.NEVILLE Town Hall,53096 Main Road
P.O.
TOWN CLERK 4= Box 1179
40 :M= Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631)765-6145
MARRIAGE OFFICER Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER southoldtown.nofthfork.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.H 1:,e,/
Permit No. I OJ� `66q
Applicant Nam
Applicant Mailing Address ',I)
Septic Tank.,'or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:
Owner Property Address:_--:te'�"
Name and phone number of contact person b3i
Tax Map No:10co Section Block Cam Lot
Cross Street 77r, 'q"e)
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WIT_V9EALTH DEPARTMENT APPROVAL
SignAt-iffle of Applicant Date
Received by:
SURVEY OF PROPERTY
SITUATE
NIATTITUCK
- TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-139-02-03
SCALE 1"=10'
MAY 16, 2007
JANUARY 20, 2010 UPDATE SURVEY
MARCH 9, 2011 ADDED PROPOSED ADDITIONS
APRIL 12, 2011 REVISED MAP
OCTOBER 24, 2011 ADDED DISTANCE TO PROPERTY TO THE SOUTH
DECEMBER 6, 2011 REVISE PROPOSED SEPTIC SYSTEM
APRIL 30, 2012 ADD NOTE FOR HOUSE TO BE RAISED 16"
MAY 10, 2012 REVISE NOTES
SEPTEMBER 18, 2012 CORRECTED SEPTIC SYSTEM DETAIL NOTES
MARCH 14, 2016 REVISE NOTE FOR HOUSE TO BE RAISE 16" MIN. TO 32" MAX.
NOVEMBER 6, 2017 REVISE PROP. ADDITIONS
MAY 18, 2018 REVISE PER S.C.D.H.S. NOTICE 02j27f2018
AUGUST 1, 2018 REVISE PROP. SEPTC SYSTEM
TOTAL AREA = 7,280 sq. ft.
(TO TIE LINE) 0.167 ac.
UPLAND AREA = 7,141 sq. ft.
WETLANDS AREA = 139 sq. ft.
EXISTING LOT COVERAGE OVER
UPLAND AREA (7,141 sq. ft.)
DESCRIPTION AREA r. nor covERacE
EXIST. HOUSE 1,079 sq. ft. 15.1%
EXIST. WOOD DECK 228 sq. ft. 3.2%
EXIST. GARAGE 373 sq. ft. 5.2%
TOTAL EXIST. 1,680 sq. ft. 23.5%
i
PROPOSED LOT COVERAGE OVER
UPLAND AREA (7,141 sq. ft.)
DESCRIPTION AREA z nor covERace
PROP. HOUSE 1 11267 sq, ft. 17.8%
PROP. PORCH 60 sq. ft. 0.8%
EXIST. GARAGE 373 sq. ft. 6.2%
TOTAL PROPOSED 1,700 sq. ft. 23.8%
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