HomeMy WebLinkAboutSavage, Sandra
,
Town Hall, 530915 Main Road
P,Q. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 7615-1800
southoldtown,northfork.net
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
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\ff\~W~\Q~ ~.~~J!!\\\ FICER
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TO: Southold Town Building Department
OFFICE OF THE TOWN CLERK
TOWN OF SOUTH OLD
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 3562
Alteration Pennit submitted by:
for a Cesspool/Septic Tank Constmction or
Sandra Sava2e
Please review the application and location map and advise if the project has received Suflolk County
Health Departmcnt approval and ifthis office may issue the permit.
Please complete the foml below and return it to me,
Linda J, Cooper
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I have reviewed the application and location map of the project cited above and make the following
recommendations: /"
APPROVE
DISAPPROVE
Commcnts:
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Signature
Da~H.t?-
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"il.~t:1 t:
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
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ELIZABETH A. NEVILLE
TOWN CLERK
"Town Hall, 53095 M!dn Road
P,O, Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
sou tholdtown, northfor k, net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
.
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10~ or Non-Residential @ $25 _
Application NO~
Permit No,
Applicant Name SOJV\ ciA ft ~ 00....'1 -f:
Applicant Mailing Address \ 'i5' \ 4 'An. \' clc\ \ 1:
€.dc::, -E:.., 11 "l (.Q ~
Septic Tank_or Cesspool-L
Brief Description of Proposed Constmction or Alteration
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Ne-v Ho,-",-S-e.
Location of Proposed Constmction! Alteration:
Owner of Property: )0 \r.n C fV\ e) '€ ('
Owner Mailing Address: \:'0. Q,O)( 6 LJ '1 ..:5cut'- 0 Ie! fit ~ II ~ II
'5\<2-e.(->,\ ~-+o\ 'OIL) ~\AV"\~
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Name and phone number of contact person SAne!.,.- F\ 'S Avo.. "1 -e. 34'S <0 ~ J., a
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Tax Map No: Section let Block I Lot_3 ~
Cross Street L0, \I Gv...) po "0 \ fw')-e
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SUR Y WITH HEALT DEPARTMENT APPROVAL
~
Owner Property Address:
Received by: ~ Co. ~
\-30-0 Cp
Date
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SURVEY OF PROPERTY
SIlVA TEl 5OUTHOLD
TOv-tN1 SOUTHOLD
SUFFOLK COUNTY, NY
SURVEYED 03-10-04
TOPO 10-08-04, PROP. HSE, 11-22-04
REVISED 01-31-2005
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W+E
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CBRTIFIED 1'0:
10811 B. NimD
('..............Jth Laud 11tIe IDsunmce Company
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EDGE OF I^IETLANDS AS
DELINEATED AND
LOCA TED BY ROBERT FOX \,
OF SEA LEVEL MAPPING \
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SUFFOLK COUNTY TAX #
1000-18-1-38
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NOTES,
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MONUMENT FOUND
PIPE FOUND
STAKE FOUND
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AREA = 40P31 S.F. or O,Q2 ACRE
FLOOD ZONE INFORMATION ANNOTATED FROM
FLOOD INSURANCE RATE MAP NUMBER 3bl03COlbb G,
TOPO ELEVATIONS REFERENCE NGVD '2Q BENCHMARK
PROPERTY ZONE R- 40
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JOHN C. EHLERS LAND SURVEYOR
6 EAST MAIN STREET N,Y,S, LIe. NO, 50202
RIVERHEAD, N.y, 11901
369-8288 Fax 369 8287 REE\\Hp server\d\PROS\04-135,pro