HomeMy WebLinkAboutPanlowski, Paul -
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ELIZABETH A.NEVILLE,MMC �y� r/y Town Hall,53095 Main Road
TOWN CLERK o P.O.Box 1179
C42 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS &. • Fax(631)765-6145
MARRIAGE OFFICER y O`' Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER �o.( �► www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD FD E C V I/ 1
TO: South fJ I� MAR 3 0 2015
Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's Office BLDG. DEPT.
TOtNN OI-SOI;MOLD
DATED: March 27, 2015
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4297 1 for a Cesspool/Septic Tank Construction
Permit submitted by:
Paul Panlowski for Mike Warlan
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
L
L rr
ELIZABETH A. NF,
VILLE e `Z O
G�r _.Town Hall, 53095 Main Roa.
TOWN CLERK y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER topy Fax (631) 766-6145
RECORDS MANAGEMENT OFFICERfol ����` Telephone (631)765-1800
FREEDOM OF INFORMATION OFFICER southoldtown,northfork.rnet
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
;C/ONTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10or Non-Residential @$25 Application No. 2 �
Permit No.
Applicant Name �d ^• �b�ff
k
Applicant Mailing Address o b�
Septic Tank. or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property:_
Owner Mailing Address: '00 46
Owner Property Address: 1( t Cyj Gu,/
Name and phone number of contact person
Tax Map No: CD' 0 Section (j Block Lot- -�=-
Cross Street
NOTE: LOCATION MAP MUST'BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Si II e Applicant Date
Received by:
y PUBLIC W
` PUBLIC 1
PUBLIC
PUBLIC W_ATER
SUFFOLK AVE. -
N EW
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�.� l;, r.; \ :.r =' . ' _ _ - - ' - - ARBA OF EX. SANITR --
' `�\ -•.:, ' __;.11f4'1 _�jl. ..-Er \ �.:,1'.`} li:.
TO BE ABANDONED BY N
t ' '` -.l. r 1 _ i � , 'i!i•: '.�%r;i.� :i1yy,..` a ': i .\ /' � _:..=.::Jt'Cr> ;;StY'n N
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411
6 8'
> 121'
TONE PATIO w1 , ROPOSED
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,
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�, -` EL 27
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150 ' MIN, zs' ,
p 81
MIN,
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"PRO POS FD SANITARY ` MIN,' DECK u +
- ` 1,500 'GAL., 8'X5' ST
(2) 8' DIA. X 8' DEEP LPS
- ' € PR
PROPOSED OPOSED
' PAVED PARKING
I
_
POOLDECK PROPOSED
POOL
22. 5
8' DIA. X 8 DEEP €
RE-EXIS' IN W D SHED
SWIMMING POOL , • €
PLUMBING
(;Q10 - ,��' o f DRY WELL EL. +32.0'
l ..:._ r
JI' ,'` ;!•" , ' , 1 �\� �1.../ € CC1 PROPOSED
GRAVEL PARKIN(
WATER SERVICE TO BE EXTENDED m s
m o , n
,� TO NEW STRUCTURE n.m � L 'xc''PR
Z= m I BA -
Z :`::,, ... ev4.w 5zc�cum 'l a jco
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p''h \ � PAVED ,
�� r- Be faS���Crf�sJ B�, 9 9 .i ` € DRIVEWAY
W �' /, C eF.� r epe•. Of Health Sal vices. €
��' '.' ' I ,.\ P' a000ll 852-570)o ;48 I-'itbi.rs In A'1:.dvarjcq \ €
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To Sche�uie Irtspetiers(s),
FL
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7. CUT ALL PIPING, CONDUIT, OR ABLE ASSOCIATED WITH UTILITIES SERVICES TO BE REMOVED OR 13
ABANDONED TO A MIN. OF 24" BELOW FINISHED GRADE. CAP ALL CONDUIT AND PIPING.
. a
8. DURING THE COURSE OF DEMOLITION AND EXCAVATION, EROSION AND SEDIMENT CONTROL MEASURES `
WILL BE REQUIRED. SEE EROSION AND SEDIMENT CONTROL PLAN FOR SPECIFICATION.
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BROWN SILTY FINE SAND, TRACE OF GRAVEL (SM) `" ";`"a'� ORY'
EV 29.0 2 0'
LIGHT TAN SAND
MED. TO FINE SAND, TRACE OF GRAVEL (SW) "ROFE��\ �
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SUFFOLK b+oum7y DE ARTm mT OF HEAU H SERVICES3 cu
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JO WATER ENCOUNTERED BAR 0 6 2015
TO 27.0' BELOW GRADE DATE HIS PCS No �lp—t�—000�
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