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--Ei:"IZABETH A, NEVILLE
TOWN CLERK
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
~OM OF INFORMATION OFFICER
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----iift.'.c~LJ!!.'l~own Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
DATED:
April 5, 2006
Transmitted herewith is a copy of application No, 3580 for a Cesspool/Septic Tank Constmction
Permit submitted by:
P,D. Carpentry and Masonrv Inc
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me,
Linda 1. Cooper
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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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DISAPPROVE
Comments:
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Dated
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EUZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD W ASTEW ATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $1O~ or Non-Residential @$25_
Town Hall, 530915 Main Roac
P.Q, Box 1179
Southold, New York 11971
Fax (631) 7615-61415
Telephone (631) 765-1800
southoldtown,northfork,net
Application No, 3.r6o
Permit No.
Applicant Name. 9, D I Cr;j)fYrty~ O-u.f; rnz~~.
Applicant Mailing Address ,- ~ ?!tn pO~ .
_ ' 1-1-0 ~ 1/101
Septic Tank -,/ or Cesspool_
Brief Description of Proposed Constmction or Alteration ~c vJ
'2. '" 0 ~e w,t>{ 6tlc't VO;-/-Ji'o(L \ A,.<{ I
eon/-! ,
Location of Proposed Constmction! Alteration:
. OwnerofProperty:~W.tV:,- ~d:t~. ttvdo~ Drt?,
Owner Mailing Address: ~ - 20 6r-anrow.;f .Av{
~ ~ 11m!
Owner Property Address: ~_ ,'l-$- ab6~
-511 0<0 C' t- ~ So..s \. <:1 .
Nameandphonenumberofcontactperson [Jalvt 0wuz.ay 111- qo~ -058
Tax Map No: Section '5 Z Block 2... Lot 20, \
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
~o--::ro..e: ~ /ton 1~
Signature of Applicant
R""~'" b$~.
Date
CBR.11FIBD TO:
Peter Drouzas
SURVEY OF PROPERTY
SIlVA TE: ARSHAMOMAGUE
TOWN: SOUTHOLD
SUFFOLK COUNTY, NY
606\\\(I~6r N'
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UFFOLK COUNTY DEP ,l:NT OF HEALTH ER .
PERMITF ,. ROVAL OF CONSTRUCTION FOR E:
SINGLE FAMiLY RES!OENC::: AND
S
DATE 5-15-o3H.s,
APPROVED
TCTA~ MAxiMUM BEDROOMS
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SURVEYED 06-18-02
REVISED 1-05-2005,03-08-2006
04-03-2006
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SUFFOLK COUNTY TAX II
1000-52-2-20.1
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PROPOSED SEPTIC TO BE THREE 6' DEEP
8' DIAMETER CONCRETE RINGS HITH
1500 GALLON SEPTIC TANK
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MAP NUMBER 36103COl5B G
DATED 05-04-IQQ8
DEED REFERENCE L, IIBB6 Gpb31 ~
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AREA; 42,45'1 SF OR O,Q1 ACRES
PROPERTY ZONE R - 40
ELEVATIONS REFERENCED TO NGVD'2Q
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SURVEYOR
N.Y.S. LIe. NO, 50202
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