HomeMy WebLinkAboutADF Ventures LLC ELIZABETH A.NEVILLE,MMC �wY° � Town Hall,53095 Main Road
TOWN CLERK � P.O.Box 1179
a i Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631)765-6145
MARRIAGE OFFICER "0 mC9y. Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER , � 4. www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICERo � „�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Southold Town Clerk's Office
DATED:: November 15, 2019
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4816 for a Cesspool/Septic Tank Construction
Permit submitted by:
ADF Ventures LLC
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 .......___._..._
rsrf ro
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) 765-5145
RECORDS MANAGEMENT OFFICER �. Telephone (631) 76.5-1800
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. '7 D
Permit No.
Applicant Name Arc �t r ' _
Applicant Mailing Address i 3 t"�cr Ni 1 ) 1(v3
Septic Tank or Cesspool.
Ilrief Description off Proposed Costruction or Alteration-
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Location of Proposed Construction/Alteration:
Owner of Property: 1`l e-f LL
Owner Mailing Address: c
Owner Property,A;.d:dress:_
Name and phone number of contact person
Tax Map No: 1m0 Section S Block ., t . Lot.._ ...._ ..
Cross Street I-Y �-Y) ,„e
NOTE: LOCATION MAP MUST BE SUBw1jrTEID APP CATION. NEW
CONSTRUCTION REQUIRES SURVEY "H `I` EP ENT APPROVAL
atur l" pli mat at
Received by: _,
TEST HOLE DATA NOTES:
TEST HOLE DUG BY McDONALD GEDSGIENOE ON AUGUST 25,2005 — 1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM
DI,56.13' D RK BROWN IRECEIVEDGG
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DARSLTY LOAM(OL)
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BROWN SILTY SAND(ML) , w SITUATE
-36.0' SOUTHOLD
c—SANo°rSW,
V) TOWN OF SOUTHOLD
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SCALE 1"=50'
j o MARCH 26, 2019
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53 PROBST DRIVE .nT,c .—
SHIRLEY, NY 11967iF7 z a MN° '
PYj'J PHONE(516J 972-5812
t • su—ydude�optoN'ne.net
` QF TEST WELL "'"
LOTS: 04 BLOCK 01 SECTION:51 DISTRICT:1000
CONIC. MON. FOUND MAP OF. I� mph
UTILITY POLE _ — .m uJ wd
„ I SITUATED AT: SOUTH..
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„-
OO WELL TOWN OF SOUTHOLD,SUFFOLK CO.,N.V.. �'1n r m„F.a
5e PROPOSED GRADE -
" CERTIFIED
' TO .-.... JOB N( 19-169
DATE: ,N 26,2019