HomeMy WebLinkAboutMattituck 2012 LLC ELIZABETH A.NEVILLE Town Hell,53095 Main Road
TOWN CLERK ,: _ P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICStt-
145
MARRIAGE OFFICER Fax(631)765-6
RECORDS MANAGEMENT OFFICER Telephone(631)7655-1-1
800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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SOUTHOLD WASTEWATER DISTRICT
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APPLICATION
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CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK L(
Residential @$10_ or Non-Residential Q$25 Application No. (�
Permit No.
Applicant Name _r�/CHi4�G A A-1
Applicant Mailing Address S Q> / 4
5-0ur0° IVY
Septic Tankor Cesspool
Brief Description of Proposed Construction or Alteration O f f?1 it t
Location of Proposed Construction/Alteration:
Owner of Property: 20jz z 4 c
Owner Mailing Address: t```i #,T-O, -A r
Owner Property Address: —. eiJT
Name and phone number of contact person R&Z ,dV .- 6731- 660-,9909
Tax Map No: Section 6 9 7 Block --f Lot
Cross Streetis�`
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signature of Applicant Date
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Received by: t f ((
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V` OV" R'" ,�, 7FHYCVCPP 4€lt/N/1/4S6EPfY ++....Ig-° iso• .- G%AUC
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T fA�PER FOOY 21.7 A. 1O !NV E -"„- -_ It C'uA I'a i fkz.7 f y^
MtNtMUM PPFP„"Fr if`8'PER FOOT ., ..
�- 1411'DIA.PIPE 27.2 ✓ fN'Vf'L W�Cva I`s�:Z3
,7 MPAdXMUM PITCH 2t.0 �-+1 UZI a
,a P" .�.� s� MINA"OA.PIPE Caf a
ALL PIPES TO BE '44, vFi_ � II
SDR-35 PVC in.
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300 S.F. i 3 d
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MINIMUM T' U
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3 FOOT MIN,SEPERA77ON D J,
FROM SEASONAL HIGH GROUNDWATER _,
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av �` III`YIYVI 7�{J
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p m Suff`opk County Ltpaltment of Heal Services
Approval for Co 'Phan SingleFamily
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RefereneeW, - tthh fir,Vit'i
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x 2c These plans have been reviewed for general confo with Suffolk
County Department of Health Services standards.relating to water sul
y and sewage disposal. Regardless of any omissions,inconsidtences or k
of detail,construction is required to be in accordance with the attached
permit conditions and applicable ands specifically waived by
the Department.This approval a liras 3 ears from the approval date,
unlessextt'end orrenewed
6 w oval to Reviewer
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SuffoCa ptOf Hee Serv6t esC�� 754,48 E ours in Adva7 `ule i i€mn(s). 2 e
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ARK K SCHWAR7Z, AIA ARCHITECT
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® � ., iJ 0. BOX 933 ;ick N.Y.S. LIC, NO.
TCHOGUE, N.Y. 11935 "
1hyl VEYORS, P.C.
MAY 1 6 2018 (fi" 1)-76"5-5020 FAX (631) 765-1
AREA=10,664 SQ. Ff. P.O. BOX 909
1230 TRAVELER STREET 'F r)
i2 SF
sq.ft. A
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1200 GAL 4'LIQUID DEPTH
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