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ELIZABETH A, NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.Q, Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 7615.1800
southoldtown,northfork. net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTH OLD
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TO:
Southold Town Building Department
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FROM:
Michelle 1. Martocchia, Southold Town Clerk's Office
DATED:
January 26,2006
RE:
Cesspool Constmctionl Alteration Application
Transmitted herewith is a copy of application No. 3560 for a Cesspool/Septic Tank
ConstmctionlAlteration Permit submitted by:
Robert's Custom Homes
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.
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I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
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Comments:
DISAPPROVE
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Signature
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ELIZABETH A, NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 153095 Main Road
P,Q. Box 1179
Southold, New York 11971
Fax (631) 7615-61415
Telephone (631) 765-1800
southoldtown,northfork.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. 3Slo0
Permit No,
ApplicantName Ke bcr-+s CU-S +0/)1 Home.s.
Applicant Mailing Address 5 0 (') I C( 1'1 to, C- r
lJ it do () I) K) 1/ er'L- AJ--( 1/ 7 Ii J-
Septic Tank-Aor Cesspool_ r
Brief Description of Proposed Constmction or Alteration :V2 Wee nsf-ru: c f, () (1 Dt"'
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Location of Proposed Co~~ction! A:teration:
Owner of Property: c.~ 4ev e.l
Owner Mailing Address:)' ~~vY\ i t'.. -( k......L-
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Owner Property Address: RijdllZ- 1=0. r IY1 Ln
o rd),1 f NY
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Name and phone number of contact person V I cl< \ TO TI1
Tax Map No: INti Section 1..5" Block 5
/ / 7jg
~35 d- ;)/0
Lot y,-/'3!
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEAL TH DEPARTMENT APPROVAL
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Vi> A<:..1 ~or1\ lie-&> /0&
Signature-of Applicant Date
Received by: ~ ~f}..,
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WRVEY OF PROPERTY
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\"'-;::~/ TOWN OF SOUTHOLD
SUFFOLK COUNTY. N. Y.
1000-15-05-24.31
SCALE: 1--40'
MA r 31, 2005
SCDHS Rel.# RIO-05-0107
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SUrfOI.K CO\Il'lT;m;A.RTMENT OF HEAJ.:m SCt\'ilC..S
PERI4\'t FOR A.PPROVAI. Of CONSTRUCTION FOR A
S\NGLV, F'AI,\II.Y RESIDENCE ONLY
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EXPIRES THRE:E. 'I EARS mOM O~.TE OF APPROVAL
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UMBERS REFER TO #MAP OF ORIENT BY THE SEA \ \ .~ C\.:JC\UA.~ ~.()1)y;~\L
IN THREE" FILED IN THE SUFFOLK COUNTY CLERK'S \'\ \ ('-:)
:- ON OCTOBER 16, 1974 AS FILE NO, 6160. \ \, \5'SD ,-S?;-. \%'\iJ'W..lU--
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SED SEPTIC SYSTEM
BEDROOMS MAX.)
00 GALLON SEPTIC TANK
DEEP ,x 8' DIAMETER LEACHING POOLS
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FLOOD ZONE X
FIRM MAP NUMBER J6103C0069 G
MA Y 4, 1998
1 am familiar with the STANDARDS FOR APPROVAL
AND CONSTRUCTION OF SUBSURFACE SEWAGE
DISPOSAL SYSTEMS FOR SINGLE FAMIL Y RESIDENCES
and wtYI abide by the conditions set forth therein and
permit to construct.
on the
The location of wells and cesspools shown hereon ore ~sE'
from field observations and or from data obtained from others.
Elevations referenced to N,G. V.D.
ANY ALTERATION OR AOOITION TO THIS SURVEY IS A, VIOLATION
OF SEt;1/0N 7209 OF THE NEW YORK STATE EDUCATION LAW.
EXCEPT AS PER SECTION 720B-SUBOIVISION 2. ALL CERTlFlCA TlONS
HEREOO ARE VALID FOR THIS MAP AND COPIES THERE:OF ONL Y IF
SAID IIAp' OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR r;;;] ,
fMiOSE SIGNA TURf APPEARS HEREON. 1'iJ ~ prof'o;x,d- e/ <:No-/ ,0/)
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