HomeMy WebLinkAboutDickerson, Betsy & Parker ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARF, IAOE OFFICER
RECOHDS MANAGEMENT OFFICER
FREEDOM OF INFOIhMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fox (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
,TO:
Southold Tow~. Building Department
Linda J. Cooper, Southold Town Clerk's Office
DATED: October 22, 2004
Transmitted herewith is a copy of application No. 3389
Permit submitted by:
for a Cesspool/Septic Tank Construction
East End Construction Services
Please review the application and location map and advise if the project has received Suffolk County
Health Department. approval and if this office may issue the permit.
Please complete the form below and return it to me.
Linda J. Cooper
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE ~ '
DISAPPROVE
Signature
Dated
Town Hall, ~ M~t,~ Road
P.O. Box 1179
Southold, New York 11971
Fax (681) 76~614~
T~lsphons (6~D
OFFICE OF THE TOWN
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residenfial(~$10 ~ or Non-Residential~$2S,
Application No.~L._~
Pet'Mt No.
Applicant Name
Applicant Mailing Address
Septic T~nlr or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner Mailing Address: IC~,g'- /t4~_ C_rr_cz~
Name and phone number of contact person
Tax Map No: / 00o Section ~ 6~- Block
/Dat~ ---
NOTE: LOCATION MAP MUST BE SUBI~/'YI'I~D WITIt APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
IS I~4~ ? ,¥0. 110£6 ON IIII~I03
-.ZX " ~O~N OF Z~UTHOLD
Y.
JANUARY Z 2004
O0
LOT L~ '~
CP. OIVELL$1~) ! 0~.
s ~,~,~/
~ l/
~ .PRE~R~D AREA
/~ / LOT 2 I
, cut / ~. ~ ,~'~~~t I
OC~' ~LL J~'+
EL,
I om fornilior with the STANDARDS FOR APPROVAL ---
AND CONSTRUCTION OF SUBSURFACE SEWAGE
DISPOSAL SYSTEMS FOR SINGLE FAMtLY RESIDENCES ~ F~. TO ~ S~a~ SV ~NT
p~/t~d wglto~ideconstructbY the c~d/dons set forth there~h ~d ~ the
~e location~ of ~eEs ond cesspo~s ~own her~n ~e --
~ ~dd ~servotions ond ~ ~ dora obt~ed ~ other&
76 5-17~
02-1