HomeMy WebLinkAboutPav r r
ul" �""
ELIZABETH A. NEVILLE MMC �`� .a, Town Hall, 53095 Main Road
TOWN CLERK P.O.Box 1179
y` m� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ° o11111111111111111111114 � Fax(631)765-6145
MARRIAGE OFFICER
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: Sabrina Born, Southold Town Clerk's Office
DATED: September 23, 2021
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 5069 for a Cesspool/Septic Tank Construction
Permit submitted by:
Megan Carrick for George Pay.
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 _ITITITITITIT
Comments: Final approval reguired from the Suffolk County Health Department
, _._m_mmm
Signature
.............�_...
Dated
ELI ETH A. NEVILLE � Town Hall, 53095 Main Road
TO CLERK P.O. Box 1179
Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS
MARRIAGE OFFICER ' Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �y" 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 V1 or Non-Residential @ $25 Application No. ��
Permit No.
Applicant Name—M(
pP � c
Applicant Mailing Address, ....__._.�. -„_......._ ....�....
Septic Tank �or Cesspoolool
Brief Descriatof Proposed
Construction or Alteration---C(
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address; Vvmyl hu lA AwA
3-:s
......... .........
Owner Property Address:_ l k r
i
...... S �:.
Name and phone number of contact person �” 1 2-`�51cl
b .. _ D
Tax Map No: IoVD Section (,�.......... BlockLot.. .-,.�............. ..e � ......
Cross Street U
V1 _, y�4. � ..... ..
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
-.., 5iglyau of���plicant � :ate ...
r
Received by, �m��
.p( m C
L 3 >: C
0 :1
I..I... 00 J 1.7 L V) 4) > E
O RFS O �- .� 3 "W cy' ,y'. 0
C O
a Q m ° to (arn a
ar "S
z i Y +
7<, p1 LL c o c rn N
La CL Z
I O -1-- JY o ._..... - m. s ^«: F c ani C
O kCD
=
W0
O vii 0 4 :02 0 o a o
Q z O N 0
0z_to
MO CA
d- � " ' °° Qom ' o
LLI
OO c a � ' z CL
O U z s
V 4 > 9 C, M e w W
�n Z w W wo
V L W,
on on 04
Or Mai .OR x dry yup Pf1 J
L.1 • sd'N WCL
rV/1'� • J yy.� .yyrs�.. h ,
� N
w C14 VCe Ca @ N 06 8 8wZ ,"
Z-WcMO>Nm Q q� // 7 �
u ,
1 aN o > 0 0 �
O rb M d '.. 'y, saa (n O.se's O `O R- big
w
cn
Big! .ua -.w
tnZ �O .
LLI � a
a�.
`w
N
Nr
', h c• � X // / _ iOSS YJA
40 P
ro
x r !
N
X a i
x �
1 / X \ i/
60
_ ./ f^+,
"
� 4T'I C
X� —58
x r
Ix
X
Zw
It
It
t �, 00
-r
? ®cl, x , +
/
1 .
\ � all
o �a
/ Ato
L1
fir} 4 0 r 1 G3
11
, l
z 21
Io
6.5
� ?Xt
j z a
T .CuLL
110
¢d Op.O C� CL
1 9 vD fjo-' t
d" 5 _