HomeMy WebLinkAboutHeins, Janet E ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York lt971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
TC
FROIM:
l ~ I fi Il TOWN OF SOUTHOLD
{JUl
[-- ~.'TSc~~n 4uilding Department
Linda J. Cooper, Southold Town Clerk's Office
DATED: June 9, 2005
Transmitted herewith is a copy of application No. 3477
Pemfit submitted by:
for a Cesspool/Septic Tank Construction
Janet E. Heins
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office Ina3' issue the permit.
Please complete the foml below and return it to nie.
Linda J. Cooper
I have reviewed thd application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Conmlents:
Signature
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICEE
.. Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.nort hfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 J or Non-Residential ~ $25 __
Applicant Name (~f l~ ~",
Applicant Mailing,~ddress ~
Septic Tank or Cessp~)ol --
Brief Description of Proposed Construction or Alteration
Application No.
Permit No.
Location of Proposed Construction/Alteration:
Owner Mailing Addres '~ ~ ~ ~y~/t'
Owner Property Address: ¢&tr) lO
Name and phone number of contact person ~ ~ '~JJ~t/9 -?~/z~--
Tax Map No: Section "~'"' /'f Block (~)~' ' Lot
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Received I~y:~)'j~
Sig~ture of Applicant
/ l~ate
SUYFOLK CObqqTY DEPARTMENT OF KP-,AL'PA b.~ v ,~..~
DF CON~FRUCTION FOR A
FORMAXG/UM OF c_// BEDROOMS
S THINE Y~.RS FROM DATE
CHANGE(S)
Health Servio~
~= SURVEY OF PROPER?
,~ -. A T SOUTHOLD
TOWN OF SOUTHOL£
SUFFOLK COUNTY, N.
1000-75-05-0R
SCALE'
APRIL 6, 2004
MARCH 21, ~005
Z
Z ~.
Elevations referenced to on oszumed datum.
orn fot37#ior w/th the S~AND~DS FOR APPROVAL
DI~OSAL S~MS F~ S~E F~IL y
and ~ ~e b~ the c~diti~s set forth therein and on the
to c~st~ct.
~e /oc~tion of w~/s ~d ces=p~ls ~own h~e~ ore
fr~ Ndd ~t&s ~d ~ rrm data obtained rrm others.
: EX~T ~ ~ ~ ~ ........
TEST HOLE
9/2/99
(6J~) 765-5ozo ~Ax (~), z~:
P.O. BOX 909