HomeMy WebLinkAboutFreeform Building partners (2) REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
t i ~ ~ ......... i ~ i; OFFICE OF THE TOWN CLEP, K
[1~ SED 20DS , :~, TOWN OF SOUTHOLD
· i~i~ko!d~J_o.~ Building 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:
Transmitted herewith is a copy of application No. 3505
Permit submitted by:
for a Cesspool/Septic Tank Construction
FreeForm Building Partners LIc.
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: y
APPROVE
DISAPPROVE
Comments:
Signature
Dated
OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
Application No.
Construction
Alteration
$10.00 - Residential
$25.00 - Non-Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
.' for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.~
APPLICANT NAME: '~lS~;~(Z.i~t, ~3~',[,~D~/~-~ P/~/"T~.
APPLICANT ADDRESS: I1~"~.'' ~,~ ~
SEPTIC ~ CESSPOOL ~
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: ~J ~_~ ~1~' . ~
TAX MAP NO.: Section /ODO Block.~ Lot /"~.~-
CROSS STREET:"~,j~/ ~ ~,--I~<:~ ' J~]' Ml~,~ 8~"~V~EU'j
BUILDING PERMIT NUMBER CROSS REFERENCE:
RECEIVED BY:
'ATE:
Town Clerk's Office
lOT ARC_A,,,a2,635 SCl. FT.
F FL ELE'V 27.5
GAR EL.Er 25.5
NOTE
LOT CLEARING SHALL BE LIMFI~'D TO I ACRE
;EIVED
COU~tTY
5 JUL A}I I0:0 G
(23.0)
N 87'41'29"W 298.36'
LOT NU~,~ 5 - ¥~¢..ANT
CERTIFIED ONLY TO:
(25.s)
N.Y. LIC. No. 048992
HAROLD F. TRANCHON JR. PENN. LIC. No. 2115-E
- 20 - 200,5 REVISE SEPTIC SYSTEM
JOB Ne. 04-262 F~LE Nc,. ZOUMAS CONTRACTING
SURVEYED FOR
LOT NUMBER 4
MAP OF ZOUMAS CONTRACTING CORP
SITUATED AT BAYVlEW
TOWN OF SOU'R-IOLD, SUFFOLK COUNTY, N.Y.
SCALE 1" = 60' DATE 10-15-2004
F'ILED MAP No. 11166 DATE 10-01-2004
TAX MAP No.(REF ONLY)1000--79--4 P/O 17.17
DISK 2004
HAROLD F. TRANCHON JR. P.C.
LAND SURVEYOR
P.O. BOX 616
1866 WADING RIVER-MANOR RD. WADING RIVER,
NEW YORK, 11792
651-929-¢695