HomeMy WebLinkAboutMartin, Debbie & Tom ELIZABET~ A. NEVILLE
T~N CLERK
REGISTRAt~ OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS M.kNAGEMENT 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 t h fork.net
TO:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town BuildiRg Department
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED: November 18, 2004
Transmitted herewith is a copy of application No. 3403
Permit submitted by:
for a Cesspool/Septic Tank Construction
Tom & Debbie Martin
Please review the application and location map and advise if the project has received Suffolk County
Health Department aplSroval and if this office may issue the permit.
Please complete the form below and return it to me.
Linda J. Cooper
· · · · , · · · · , · ·
I have reviewed tire application and location map of tim project cited above and make the following
recommendations: ~
APPROVE
DISAPPROVE
Signature
ELIZABETH A. NEVILLE
TO~WN CLERK
REGISTIb'YH OF VITAL STATISTICS
~,qARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORI~iATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoidtown.nort hfork .ne/
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 C_~ $25 __
Applicant Mailing Address 5- ~x,~_ L~ ·
1
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
; q (5( .
Application No.5 b~ ~'-~
Permit No.
Location of Proposed Construction/Alteration:
Owner of Property: r I~
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person ~ ~.~4,,~. lk\~o~ l/,,q 2~$ ~ ~t '7 S'q~
TaxMapNo: Ic'~[ZS~tion~ ~?-~ Block ~ ~t d~.l~
Cross S~eet ~~ ~ ~
NOTE: LOCATION ~ MUST BE SUB~TTED WITH ~PLICATION. ~W
CONSTRUCTION s~Y ~TH HE~TH DEP~TMENT APPROV~
Silage of Applic~t Date
/
Map of Lot 25
"Map of Laurel Links"
Filed: November 23, 2001, Map Number 10712
Situated at Mattituck
Town of Southold, Suffolk County, New York
District 1000 Section 125 Block 4 Lot 24.18
ANY ALTERATION OR ADDITION TO THIS SURVEy IS A VIOLATION OF SEC'lION 7209
OF THE NEW YORK STATE EDUCATION LAW.COPIES OF THIS SURVEY MAP NOT
BEARING THE LAND SURVEYOR'S ORIGINAL SIGNATURff AND INKED OR EMBOSSED
SEAL SHALL NOT BE CONSIDERED A VALID TRUE COPY.
THIS PARCEL IS SUBJECT TO ANY EASEMENTS OR KESTRICTIONS OF RECORD.
ELEVATIONS REFER TO AN ASSUIvlED DATUM,
ANTHONY ABRUZZO R.L.S.
REGISTERED LAND SURVEYOR
1500 Hortons Lane
Southold, New York 11971
(631 )-209-0676
SURVEYED: March 27, 2004
Scale 1" 3Q~0' File~NN~2733