HomeMy WebLinkAboutFox, Robert
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Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
ELIZABETH A. NEVILLE
TOWN CLERK
REGlSTRAR OF VlTAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INF~RMATlON.Of'F.ICER
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.', OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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FROM:
Lynda M Bohn, Southold Town Clerk's Office
DATED:
September 28, 2006
Transmitted herewith is a copy of application No. 3630 for a Cesspool/Septic Tank Construction
Permit submitted by:
Robert E Fox
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.
Lynda M Bohn
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I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
~
DISAPPROVE
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Signature
/tJ~.. AI,
Dated /' /
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
sou tholdtown. northfor k. n et
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$IO /' or Non-Residential @$25_
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Application No.':':) L' -)\.....
Permit No,
Applicant Name ~6Pez:l f'. ~X
Applicant Mailing Address 5 \N I Csu--J (.\ M \'GfilI
~ rtX:\-eyION N'I L!7DL
Septic Tat1k ../ or Cesspool_, 0
Brief Description of oposed Construction or Alteration N f'W 4.:VIYuc::l). ~ r-
Location of Proposed C~~ruction/ A1terat~:
Owner ofProperty:~ o'Ok'e::I r:: ~ .
OWl1er Mailing Address: Fi (}J\ tswAM. 1> A--ll~
'b~l~ NY
OWl1er Property Address: 99>0 E'J ee.~~N D;<..
Cu\d~~ ~~
Name and phone munber of contact person <.::>'R-eJ:>7 L~ (.,,3 \-374- 190 Co
Tax Ma~: (~oa Section Block 0 ( Lot ~
Cross Street l)-
NOTE: LOCATION MAP MUST B
CONSTRUCTION REQUIRES SUR
Received by:
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SURVEY OF
LOT 13
SUBDIVISION MAP OF
WOODS AT CUTCHOGUE
FILE No. 8717 FILED MARCH 23. 1989
SITUATED AT
CUTCHOGUE
TOWN OF SOUTH OLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-102-01-4.13
SCAli 1 "=50'
JULY 10, 2006
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1. ELEVATIONS AR[ REFERENCED TO AN ASSUMED DATU"
EXISTING ELEVATIONS ARE SHOWN THUS: ..5QJ)
2. REFER TO FUD ...... FOIl TDT HOlE DATA.
3. WlNlUUW SEPTIC TANK CAPACmES FOR A 1 TO '" BEDROOM HOUSE IS 1,000 GAlLONS.
1 TANK; S' LONG. "'-3- WIDE. 6'-7- DEEP
.4. ~ LEACHI~ SYSTEW F'OR It. 1 TO .. BEDROOW HOUSE IS 300 sq It SIDEWAU. AREA.
1 POOl; 12' DEEP. S' dla.
e PROPOSED EXPANStOH POOl.
~ PROPOSED LEACHING POOL
~ PROPOSED SEPTIC TANK
5. THE LOCATION or WEll.S AND CESSPOOLS SHOWN HEREON ARE FROW FIELD
OBSERVAmNS AND/OR DATA OBTAINED FllOM OTHERS.
THE
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UtWITHOlIZED AlTERATION OR ADOfTlON
TO THIS SUR'f'EY IS A 'MI../tTlON OF
5ECTlClN 720e Of THE NEW YORK STAlr
EDUCATION lAW.
COPIES Of THIS SUMY MN' NOT BEARING
lHElANOSUIM:'I'OIt'SNCEDSfAlOR
oeossm Sf'AL StW..l NOT lIE CONSI)(JfEl)
TO BE A VAUD mu: COPY.
CElI'T1FICA11ONS INDlrATm HE:R[CN SHALl.. RUN
ON...Y 1'0 THE POt!KlH fOR WHOM TltE SllIMY
IS PflEPMED, AND ON .. BOWF 10 114:
TI11..E COMPNtf, QCMJlNIlENTAl.. NJtIDfCr N<<l
l.DQrfG INSm\IIlC>>l ustm HER(ON. At<<)
10 THE ~ OF 1HE I.DmtG INSf\-
nJ'TION.\,oEft,........cooNS/lllE.Nl7l'"1RIliNSf!lWllE.
THE EXISTENCE Of IIOHT OF WAYS
>>IIfJ/OIt. tAKMDfJS OF' RECOID, IF'
ANY, NOT SHOWN ~ MOT 0UAIUlNTE[D.
AREA
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N.Y.S. Uc. No. 49668
A. Ingegno
and Surveyor
rtfJe Surwys - SubdMaions - Site F'kJn. ~ CorJ8fructioo Layout
PHONE (631)727-2_
OffiCES LOCAW AT
322 RtWD<E AVENUE
RNERHEAD, New YOf1l; 11901
Fax (631)727-1727
....". AJJORfSS
P,O. 80. 19J1
RiverMod, New York 11901-0165