HomeMy WebLinkAboutColombo, Charles P ELIZABETH A. NE~r~ TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
i OFFICE OF THE TOWN CLERK
JA~ 2 5 f'~?~ ' t TOVCN OF SOUTHOLD
T~: ,7:2. Sg_uthokl'~a~uilding Department
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: January 25, 2005
Transmitted herewith is a copy of application No. 3427 for a Cesspool/Septic Tank Consltuction
Permit submitted by:
Charles P. Colombo
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
Comments: ~
Signature -
· ELIZABETH A. NEVII
TOWN CLERK
REGISTKA~ OF VITAL STATISTICS
MAHRIAGE OFFICER
RECORDS 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.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10
Applicant Name
__ or Non-Residential @ $25 __ Application No.
Permit No.
Applicant Mailing Address '~ ~- ~> >~, ~:> (
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: C'~ q rt_t~ ~
Owner Mailing Address: '[P. ¢. 1~ o
S'oc'rt '*q'-/ t.q'4 q
Owner Property Address: ~5;~ VtCi~[2~
Name and phone number of contact person
Tax Map No: Section q~ Block fl Lot
Cross Street ~'"M ~ ~ Vxl ~ ~,.~
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVF~ WITH ~,~TH DEPARTMENT APPROVAL
~ Signature of Applicant Date
Received by:, 1,~"% ) ~(,--'
51'TUA'I~ BAI'VlrdN
TOI~IN, 501.tTHOI_D
51.,,'t'"T', OLK GOUN'rT', N'r'
,SURVEYED 11-01-2004
.5~FFOLK CCJN'rf' TAX
1000-'7b-q-T'/
OIo~ E Colombo
." Hous~
oUFFOLK COtE,7~: Di2'~ARTME, NT OF .E2ALTH SERVICES
,,,o,,, ',,%
Proposed ~pl:lc
~' dlo. 4' deep CP%
N
hole
0
Test Hole~'°
HcPonold
("oeosoienc. e
el = 15'
10-0'7-04
~RAtI~41d_..~c~ALE I"=
NOTES,
ELEVATION5 REFERENCE EAJFFOLK COUNTY TOPO MAP5
SETBACK5 BASEP UPON LAIN5 ~RTAININ~ TO NON-~NFO~IN~ LOT5
PANEL LIE5 ENTI~LY IN FL~D ZONE X A5 PE~ FIRM ~AP ~.
~lO~{OO ~ DATEP HAY 4, Iqqb
~RRO~DIN~ ~E~IG ~ ~Lh L~ATION5 B~ OTHER5
~E~ROON~ OTILITIE5 ARE ~HO~ F~ THEIR EXlSTE~E AN~ NOT
5~¢1FI6 L~ATION.
AR~A = 21~2~ ¢ or 0.4~ ocre~
OL
6 EAST MAJN STREET N.Y.S. LIC. NO. 50202 "
~, N.Y. 11901 '
369-8288 Fax 369-8287 REF.\~Ip s~rvcr~d~PRO$\O4-300.pro ~
JOHN C. EHLERS LAND SURVEYOR