HomeMy WebLinkAboutDill, James ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
TOWN OF SOUTHOLD
;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 To;vn Clerk's Office
DATED: May 26, 2005
Transmitted herewith is a copy of application No. 3470
Permit submitted by:
for a Cesspool/Septic Tank Construction
James Dill Jr
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 ~
Comments:
DISAPPROVE
Dated
ELIZABETH A. NEVILLE '"
TOWN CLERK I~,l .. -
REGISTRAR OF VITAL STATISTICS
MARR~ER ~ '
RE C 0 RDS.~d~k~GEM~ FF ICE R
~ ~v ] OFFICE OF THE TOWN CLERK
~PLICATION
CONSTRUCTION or ~TE~TION PE~T
CESSPOOL or SEPTIC T~
..~Town Hall, 53095 Main Road
P.O. Box 1179
Sou~chold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.ne/
Residential ~ $10 ~, or Non-Residential ~ $25 __
Application No5 ~/7'0
Permit No.
Applicant Name ~._~ ~'. T),]l ~
Applicant Mailing Address ~. O- ~1~ ~")-
Septic Tank ~ or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: ,._~'~._ ~'. ~1~'11
Owner Mailing Address: ~. t~. l~,,t ~r.~.
Owner Property Address: ~'P"~,.)acA~.
Name and phone number of contact persoa~
Tax Map No:lOoo Section
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION, NEW
Received I~y: [ ~. ~',.__~ ~
51TUA'I"~, NP_IN 5Ut~=OLK ~
COUNTY', N'~
SURVEYED O5-21-OI,
TEST HOLE APPEg 06-26-01
PROPOSED A~TIONS O2-10-2OO5
AMEN~E~
SUFFOLK OOUNT~ TAX ~
I000-117-10-4.2
CEF2-.TIFIEE; TO:
JAMES DILL
dd C So/v S
NOTES:
At2.EA = 4q,.546 SF OP- l.O'q AC..P. E5
ELEVATION5 ~EF. U~5 NOV~ '2q PATDM
d
JOHN C. EHLERS LAND SURVEYOR
6 EAST MAIN STREET N.Y.S. LIC. NO. 50202
RIVERHEAD, N.Y. 11901
369-8288 Fax 369-8287 REF.\~I-Ip server\dLPROS\0 I- 196a.p~r.6
®P. APHIO SC, ALE I"= 40'