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ELIZABETH A. NIgVII~I~ ¥° TOWN CLERK
REGISTR~-R OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS 32kklqAGEME~qT OFFICER
FRIgEDOM OF INFOP~MATION OFFICER
To~N O~ ~O~I-IO~D
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
DA]~BD: August 11,2004
Tra~] ~Baitted herewith is a copy of application No. 3363 for a Cesspool/Septic Tank Construction
Pe~k submitted by:
pl~b review the application and location map and advise if the project has received Suffolk County
H~ Department approval and if thls office may issue the permit.
pte~e complete the form below and return ~t to me.
Linda J. Cooper
I h~e reviewed the application and location map of the project cited above and make the following
reckSinmendations:
APPROVE J
DISAPPROVE
CSmm~ts: ~
Signature
Dated
ELIZABETH A. NEVILLE
ToWN CLERK
REGISTRAR OF ViTAL STATISTICS
MARRIAGE OFFICER
P~ECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.nor~hfork.ne~
OFFICE OF THE TOWN CLERK
TOWN OF sOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPL?CATION
CONSTRUCTION or A~TERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10_/°r Non-Residential ~ $25
^pp oation O. 5 __
permit No.
Septic Tank or Cesspool__ .
Brief Description of Proposed Construction or Altcratton.
Location of Proposed Construction/Alteration:
Owner of Property:
^ ...... ddress' f'~'
tr~rner Mailing
Nme ~d phone nmber ~22ntact P:
T~ Map No: Section ~
ross Street
C ....... ~"""~D WITH APPLICATION. NEW
~.Tc,.,r~, LOCATION MAP MUST BE ~sutitvt~t~_, ..... ~OTiVIENT APPROVAL
~"-'~'~: -- ~ ..... ~tmvF. V WITH ltEAL'IIa
CONSTRUCTION RE~utt~J~O ~' ..... ~ ~--
~i~a~e of Applic~t
Received by~ ~'
_~lJ~/L~f' OF LOT ~,
FINAL PLAT I~,OOt~C, OVE tE~TATE~
Fll i=D JI~ItE II,~OOI Flit= NO. IO~-/
~ITUAT~: ~POI~T
TOINN: ~I)THO! ~
5UFI=OLK GOUNT'K, N'r'
5URV'E.¥EO
AMENOED 05-1~-0~
PROPO~EO AC, TION5 01-21-04
5UI=I=OLK C. OUNT'¢ TAX
IO00-~-~-Iq.5
N
LOAH
~IrRF~ TbLREB ~ FROM DATE OF APPROVA~
NOTES:
0 PIPE
· STAKE
GEHL ANNOTATED I=ROM NY'5 DEC. C.OAETAL
EROSION HAZARD AREA HAP TOHN OF=
.~DUTHOLD; SUFI=O/t(. C.OUN'F'¢, N.h'.
PHOTO No. ~1-606-,~5 SHEET 14 OF 4q
PARC.FL LIE.~ ENT[RELh. IN FLOOD ZONE X
A5 DETE:'RMIN~=D I=ROM FIRM MAP
NO. ~610~C,.015"1 ¢ DATED MAh. 4, I¢f'~¢
TEST HOLE SHO.t, IN ON FILED MAP
AREA = 46.5'7-/ 5F OR 1.0"1 AC. RES
~RAPHIC 5GALE I"= 40'
]
JOHN C. EHLERS LAND SURVEYOR
6 F~MST MAIN STREET N,Y.S. LIC. NO. 50202
RIVERItEAD, N.Y. 11901
369-8288 Fax 369-8287 RF, FX~Ip servefld~ROS\03-165.pro