HomeMy WebLinkAboutBerwald, David ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
DEC
2
2~'Tow~Jl~lail, 5S096 Main Road
'~ P.O. Box 1179
....... -~utholcl, New York 11971
~"~ "' '~' D F~ (631) 765-6145
: '~ :'- '~'T~one (631) 765-1800
southoldto~.nor th fork.net
OFFICE OF THE TOV~N CLERK
TOWN OF SOUTHOLD
TO:
FROM:
DATED:
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 3553
Construction/Alteration Permit submitted by:
David Berwald
Southold Town Building Department
Michelle L. Martocchia, Southold Town Clerk's Office
December 23, 2005
for a Cesspool/Septic Tank
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 J
DISAPPROVE
Comments: ..~.f~.~/ ~ t~~~
Signature
Dated
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MAHRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFOPA/ATION OFFICER
.,..Town Hall, 53095 Main Road
P.O. Box 1179
SouLhold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
oFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL er SEPTIC TANK
Residential @ $10 /or Non-Residential ~ $25 __
Application No. ~c~ ~ 3
Permit No. ~e.7 q ~
Applicant Name '~ ~ :~[ ""~'C'~ ~'"~[ c~[
Applicant Mailing Address I g':;L 5''
Septic Tank ~or Cesspool
Brief Description 9f Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact per~on
Tax Map No: '~'t ~'&~'l'Section
Cross Street <~ '"'" -~
BlockO ~ ~ ~-
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
Sigh~l~e of Applicant Date
Received I:;y:~C~)( .f~~?_
SURVEY OF
PROPERT'Y
A T EAST MARION
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N
1000 - 22'- 2.- 3. 0
Scale: 1"= 30'
Aug. 22, 1997
yul,~y. R~ 200~_(oddilion$)
I0, EOO5' (revldo~l
~UFFOLK COUN~ DEPARTMENT OF H~ALTH ~RVIC~
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
EXPIRES THREE YEARS FROM DATE & APPROV~
REFERENCED ,TO THE FIVE
TEST HOLE
4/27/04'
,,~ ~o
· - PREPARED
~ PA TTY BER~ALD
FOR I REQUIRED
BY HEALTH
I00,00'
A VENUE
AR£A - 14,633 sq. ft ( to tie line )
[516) ~65 - 5020
T ~LY ~ c~Y ~ ~ ~ T~ ~ "~ ~ P, O, BOX 909
~ ~ ~ ~ ~L ~ U~ ~ C~Y 1830 TRAVELER STREET
~ ~. ~$~A$~C~ SOUTHOLD~ N.Y. 11971
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