HomeMy WebLinkAboutHorton, Debra (2) ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
OF INFORMATION
OCT 2 4 2005
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
~artment
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: October 21, 2005
Transmitted herewith is a copy of application No. 3531
Permit submitted by:
for a Cesspool/Septic Tank Construction
Debra Horton
Please review the application and location map and advise if the project has received Suflblk 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
Dated
OFFICE OF 't'" ~: i'OWN CLEg.K
TOWN OF SOU'filOLl)
EL/ZAI~ A. NEVILLE, TOWN CLERK
P.O. BOX i 179
SOUTHOLD, NEW YORK 11971
Telephone
(63~) 765-1800
Application No.
Construction
Alteration
$10,00 -Residential
$25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
DATE , ~ "~ , .....
/,.
{~ ~ ' . .~ ,,
SEPTIC~ CESSPOOL
LOCATION MAP: Must be attached hereto before permit may I~e issued,
TAX MAP NO.:
CROSS STREET:
Section_' .' ~'~ Block
DATE:
BUILDING PERMIT NUMBER CROSS REFERENCE:_
Town C~rk~s Office
No, 49~1251
Oua~fied ~ Suffolk C~oun~y ~,.- r
Commission E×p~re$ ~,!cr*: ;~,,,~l,-,) ~
SURVEY OF PROPERTY
AT CUTCHO~ UE
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
I000-83--01-15
5"C~ L~.. 1'=,.90'
JANUARY I~ 2004
Nov. 19, ~004
CAVATION INSPECTION R~QUIR
FOR ~ANITARY SYSTEM
BY FqEALTH DEPARTMENT
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YPICAL FULL CRIB
£XC~P T AS PER ,~C170RI 7209- ~ VISION 2. ALI. C~ ~R'ICA DON~
HEREON ~E VALID F~ ~S MAP AND C~IES ~E~ ~ Y F
SA~ M~ ~ C~IES ~AR ~E I~D ~ ~ ~ ~
~0~ ~A ~RE A~ARS HERE~.
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CONSUL TIN~
( 516)
CROSS SECTION SEPTIC SYSTEM
LOT NUMBERS REFER TO "MAP OF VISTA BLUFF" FILED
IN THE SUFFOLK COUNTY CLERK'S OFFICE j~
15, 1968 AS FILE NO. 50~0.
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ELEVAnONS REFERENCED TO N.C. ~D / [~ ._ ~ '~
AREA=22,498 SO. Fr (~3~) 7.5-~2o FAX (*~)
P O. BOX ~9 ,
12~0 mA~LER s~Erl