HomeMy WebLinkAboutLuniewski, Thomas ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
~[ i TOWN OF SOUTHOLD
TOW~'! DF
TO: Southold Town Building Department
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southaldtown.northfork.net
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED: July 29, 2005
Cesspool Construction Application
Transmitted herewith is a copy of application No. 3493
Permit submitted by:
for a Cesspool/Septic Tank Construction
1V/nnzi Homes for Thomas Luniewski
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me. Thank you.
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE ~
DISAPPROVE
Comments:
Signature
Dated
OFYlCE OF TI~ "fOWN CLERK
TOWN OF ~OUTIIOLD
I~IZAflET[I A. NEVILLE, TOWN CL~RK
P,O, [}OX 1179
$01~0~, ~N~ ~,/YORK 11971
Telephone
(516) 765-1801
Application No.
Construction
Alteration
$10.00-Residential J
$25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
APPLI,CANT ADDRESS:
',Jr ' 717o ..
SEPTIC / CESSPOOl' · ......... ' .......... ··
DESCRIPTION OF PROPOSED..CONST. RUC~ION?~.Rm."~.E.~.~N:
',
LOCATION MAP: Must be attached hereto· before.,"permit,"may/be:issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION·:. OWNER OF PROPERTY:
OWNER MAILING ADDRESS: t~ ~~ ~T~ '
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO,; Section j~[, Block
CROSS STREET; /Y~"')C'L~---
.Lot ~. ~
BUILDING' PERMIT NUMBER CROSS REFERENCE:
RECEIVED BY:
DATE:
· Town Clerk's Office
Young & Young
400 Ostra~der Ave~xe, Riverhead, New York
63 ~- 727-2303
Tho~ C. ~olpe~t, ~ofes~l
Robert C. T~t,
Roland E. P~h~ La~c=pe
Dougl~ E. Ada~, ~ofes~n=;
HEALTH DEPARTMENT USE
NOTE
AREA = 1,4270 ACRES
· VERTICAL DATUM
· FILL REQUIRED
= N.G.V. DATUM (M.S.L. 1929)
= 800 C.Y. +
NOTE CHANGE(S)
ENGINEER'S CERTIFICATION
· I HERESY CERTIFY THAT THE WATER SUPPLY AND SEWAGE
DISPOSAL SYSTEMS FOR THIS PROJECT WERE DESIGNED BY ME OR