HomeMy WebLinkAboutSpeyer, Jim & Karen
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ELIZABETH 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
FREEDOM OF INF.:.O~FICER
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Tt~1fih6ItT~wn Building Department
FROM: Linda 1. Cooper, Southold Town Clerk's Office
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
DATED:
Transmitted herewith is a copy of application No. 35980r a Cesspool/Septic Tank Construction or
Alteration Permit submitted by:
Samuel & Steelman
Please review the application and location map and advise ifthe 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 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
Comments:
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Signature
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Dated' ,
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Telephone
(631) 765-1800
Application No.~
Construction
Alteration
$10.00 -Residential - ~
$25.00 - Non-Residenttai
oma OFTBB TOWN CLERK
TOWN OF SOl1l'HOLD
EIlZABETII A_ NEVILLE, TOWN CLERK
P.O. BOX 1119
SOUlllOLD,NEWYORK 11971
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee -$
DATE S /1 / 0 ~
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. APPLICANT NAME:1.itlH.Ue.U J lft~
APPLICANT ADDRESS: .2.5"2..35 Ma.Ut R()~
Cec.tclt.~. N.'{, 1f9!JS
/' CESSPOOL
SEPTIC
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST,RUCTION OR f'.L~RATION:
OWNER OF PROPERTY:-.JltAf "f:!a,~ ~~
OWNER MAILING ADDRESS: Lf,5"t) f&M1 ,"kif ~A.1€. I~ 3A_
1'vW t{&rlt..' t\1,r' J ~O 2.,,/
OWNER PROPERTY ADDRESS: 1!:~tz' $:t.
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO.: Section 1(1 Block 10
CROSS STREET: fiK.6rltr $ffld-.
Lot
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BUILDING PERMIT NUMBER CROSS REFERENCE:
.- ~1ipPlicant
RECEIVED BY:~ _ ~
. own erk's Office
DATE:-d13\rb
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~TRUCTI..lRE TO BE DEMOLISHED
a.ND ~11. T FROM DASHD 1.INE
ro THE 50UTH
:><IST. S'c.JI'iA Jl'4ATER
-1t:I~ AND SERVICE
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K COUNTY DEPARTMENT OF HEALTIi SERVICES
PE~~~ APPROVAL OF CONSTRUCTION FOR A
I /' Ii LE FAMILY RESIDENCE ONLY
. TB /1., kz.. 05 S REF' i?L.",
. NO. NVv5-0205
APPROVED cfvr-nt-
MAXIMUM OF..k.. BEDROOMS
EXPIREs l1lREE YEARs FROM D4TB OF APPROVAL
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EXCAVAtiON IN PECTlON RiQUIRED
;fOR SANfARY SystEM
;By HEALT DEPARtMENT
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Abandonment . g sanitary system mu~ in
~ ith department requirement $ubmit
complctecrfot WWM. 0 ~G as proof. /
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PROPOSED SANITARY SYSTEM
(1)- 1,500 6AL. SEPTIC TANK
'1'4./ e" THIC.K REIFORCED SLAB
(e)- eFT. DIA. x :2 FT. DEEP
LEAC.HIN6 POOLS
(4)- eFT. DIA. x :2 FT. DEEP
EXPANSION LEACHIN6
POOL (FUTURE )
B I
~ 15
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TEST HOLE DATA
(TEST HOLE DUG BY McOONA~O GEOSCIENCE ON 01
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