HomeMy WebLinkAboutMcCall ELIZABETH A.NEVILLE, MMC r Px�� � Town Hall, 53095 Main Road
TOWN CLERK �� P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
Fax(631)765-6145
MARRIAGE OFFICER �� �� , h Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER ') www.southoldtownny.gov
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Southold Town Clerk's Office
DATED: November 8, 2019
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4813 for a Cesspool/Septic Tank Construction
Permit submitted by:
Isaac C11y Coffey
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
ea
ELIZABETH A.NEVILLE �� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
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 1- Application No.
Permit No.
Applicant Name ') ... -.. 99L, _ w�....... ...
Applicant Mailing Address.._... ... �" �' .._� r . "
Septic Tank ,�`or Cesspool
Brief Description of Proposed Construction or Alteration .„ � 41
...
.... ............A __.._ _...._m.. ... ...
Location of Proposed Construction/Alteration:
p Y 9 ( Coq.
Owner of Pro e��t : RV��c.f m
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Owner Mallin Address:.,,
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Owner Property Address:
Name and phone number of contact person
Tax Map No: Sectior. Block r L,ot CA
Cross Street ! ..... �i� � ....
NOTE: LOCATION MAP M6ST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH I)EPARTMENT APPROVAL
Signa d e of Applicant"' Date
ye'
Received b .,
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400 Ostrander Avenue,Rlverheod,New York 11401
teL 631.1222903 fax.631.727.0144
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Sr-NA TO EXTEND WATER MAIN Thomas G.Wolpert Frofesslanol Engineer
WEST FROM SOUTHAE5T Douglas E.Adams Professlonol Engneer
CORNER OF MAIN ROAD AND Robert G.Toot,Architect
:fit LINDEN AVE.
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Water Braes ruji-be inspected by the
Suffolk County Dept,of Heath Services.
aH 852-2100,24hours nn advance,
to schedule inspection(s),,
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ENGINEER'S GERTIPIGATION
• I HEREBY CERTIFY THAT THE WATER SUPPLY(S)AND/OR SEAAGE
DISPOSAL 5Y5TEM(S)FOR THI5 FROXOT WERE 1JE516NED BY ME
OR UNDER MY DIRECTION.BASED UPON A CA FU ✓4N€} OROUGH
STUDY OF THE SOIL,SITE AND GROUNDWATER
/EX15TIN FACILITIES,A5 PROPOSED,CONFORM TO TH DEPARTMENT OF HEALTH SERVICES CONSEFFECT AS OF THI5 DATE.e.d/HOWARDWYOUNG,NY.S.L.S.NO.45S4SnTHOMASC.WOLPERT,N.YS.P.E.NO.6I4bDOU6LA5 E.ADAMS,N.Y.S.P.E.NO.808415t1 VEYOR'S GE TIPIGATION
I HEREBY CERTIFY THAT THI5 MAP WA5 PREPARED UTILIZINGBOUNDARY AND TOPOGRAPHICAL SURVEYS MADE BY U5 AND/OR BY
OTHERS.