HomeMy WebLinkAboutFerlin, Dennis o��pF SO(/Tyo!
ELIZABETH A. NEVILLE Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS G Q Southold, New York 11971
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ,M Telephone (631) 765-1800
COU
FREEDOM OF INFORMATION OFFICER fY I 1 southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
PIIHI _ 7 TOWN OF SOUTHOLD
>✓ — Svutlr6ldTown Building Department
FROM: Michelle L. Martocehia, Southold Town Clerk's Office
DATED: April 27, 2007
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 3704 for a Cesspool/Septic Tank
Construction/Alteration Permit submitted by:
Dennis Ferlin
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.
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: � -
Signature
O4 / 47
Dated
�gOFFO(,�c
ELIZABETH A.SEVILLE h`t`� Yf. Town Hall, 53096 Main Roe(
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS od Southold, New York 11971
MARRIAGE OFFICER Gy Fax (631) 766-6146
RECORDS MANAGEMENT OFFICER �fo� � Telephone (631)766-1800
FREEDOM OF INFORMATION OFFICER 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 N —/7_b J
Permit No.
Applicant Name h Q o n i,C -<eN 1/ -7
Applicant Mailing Address 26&,V AE /1 e TT /q G t
ZZ -79-3
Septic Tank✓ or Cesspool
Brief Description of Proposed Construction or Alteration �o�e �1nt i�4 J�Of/SP Liz
Q�/SPr1)Fn� /L/Ai� iG oR i loo 777cXF�c�Rtihr PAck pc( ,r-
a'oPJr
Location of Proposed Construction/Alteration:/
Owner of Property: Delco l C
Owner Mailing Address:_ 3(0 6 9 b e In O T T ff U ez
Owner Property Address: riq%p N"(� L ziwe-
J0a ±h0Id �tl-y // 9 � /
Name and phone number of contact person E/ - / 706
Tax Map No:/Oop Section -787 Block 0,V Lot o2
Cross Street A1611V 1319 N t/ P uJ
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SUR( Ty WITH) r DEPARTMENT APPROVAL
, - 3- /y -o,7
ature of Applicant Date
Received 421h2 �
- NAIN '.
BAY�'IEII' ROAD :
N
�C,
8 �
-W LOT 21 c'P
WE"� (DWELLING)
e ,,, 2�s.1e' 0'N SURVEY OF PROPERTY
6ELL N 85.03'40' sk1kade fen� -- --- MON AT BA YVIEW
0 FE 5' MIN. EL. 12.1,
STAKE a
�+ EL. IJ.1 M L) O e TOWN OF SO UTHOLD
ST =�
v O EL' IJJ LP SUFFOLK COUNTY, N. Y.
'7d Z 36.0 W A R 1000-78-04-24
►< o r 5.0' O R SCALE. 1'=40'
g p s.D' •3� LOT 22 m o MARCH 20, 2000
JANUARY 12, 2007 (PROPOSED HODS
iA 4.0 k QL
`fid yx e.e
2 46 N 196.6 SUFfOIK COUNTY DEPARTMENT OF HEALTH SERVICE
u W
PRO°. DRIYEWA 30.2' / PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
56 a I£ al r MON SINGLE FAMILY RESIDENCE ONLY
v 6. a5•N SPUT RAR FENCE
FE FC EL 11.6' \ WELL
x ROPOSED HELL , 61,5 d3 IS ro ,'/
�M EL n.6 210.50 Ey` DATE -5/!o 07 H.S R F. No. p.,e)
S 86'31'10' �✓ rss• _ 7-oC/�
EL. 11.6' \6£ c.P. APPRoVEo
LOT 23 FOR MAKIMU BER00AiS
(DWELLING)
(WELL LOCATION UNKNOWN) EXPIRES THREE YEARS FROM DATE OF APPROVA..I
I 4,5�
Fr
EXCRYATION INSPECTION K- SQUIRED #; '
NTQiPABrIIKIrT it
ELEVATIONS REFERENCED TO AN ASSUMED DATUM.
I am familiar with the STANDARDS FOR APPROVAL
AND CONSTRUCTION OF SUBSURFACE SEWAGE Epp Ngw
DISPOSAL SYSTEMS FOR SINGLE FAMIL Y RESIDENCES 5(P T M I p
and will abide by the conditions set forth therein and on the 1� E �F
permit to construct.
The location of wells and cesspools shown hereon are
from field observations and or from data obtained from others. 9
ANY ALTERA77ON OR ADOI770M TO IHIS SURVEY IS A VTOLA77ON ECONIC U 6
OF SEC77ON 7209 OF THE NEW YORK STATE EDUCA77ON LAW. (631) 765-5020 5-17:
EXCEPT AS PER SEC77ON 7209-SUBDIVISION 2. ALL CER77RCA77ONS
HEREON ARE VALID FOR THIS MAP AND COPIES 7HEREOF ONLY IF LOT NUMBERS REFER TO -MAP OF COREY CRL-EK ESTATES- P.O. BOX 909
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR FILED IN THE SUFFOLK COUNTY CI FRK'.0 DFvTrF nN AI r. 1230 TRAVFI FR .STRFFT
W InoC Cl/A/ATI/Mr