HomeMy WebLinkAboutBest, Robert
ELIZABETH A. NEVILLE ..,
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECQRDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
RECEIVED
Qel 1 5 2Ujj
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Town Hall, 53095 Main Ro
4 .
P.O. Box 1179
Southold, New York 1197
Fax (631) 765-6146
Telephone (631) 765-180(
southoldtown.northfork. n<
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
SouthoM Tow!! Cler.
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $IO~ or Non-Residential @$25_
JI1 ~K. JJf/w/l7V7Z--
Po /.XJK 9':33
(AJ'[[... tI-O',:; C/F
Septic Tank_or Cesspool_ '
Brief Description of Proposed Construction or Altemtion Nt: CA../ ..rIEl'" 72c /'y/lZ ""1
Applicant Name
Applicant Mailing Address
Application No. 37 S-h
Permit No.
1193)-
Location of Proposed Construe 'on/A1teration: AA
Owner of Property: O(,&(L tf /v(/}v.l,E Ef
Owner Mailing Addre:j1~ ~ ~ ~ ~.41 J 1/'Vb ~ .
- L-_ (_At. J IL <; . t11 2 J I J> S"
Own~ProportyAdd=, ~ '0 ~::.t<~'("~ C~;
-G(I( _J::>_AJ _ J J _
Name and phone number of contact person 1'1"1.eJC- SC Ifw"l e.r z... 7.11--';1 ". J-
Tax Map No: Section 7 CJ Block /3 Lot Z (). I'
Cross Street ? IN€.. rJe.-e:E )t--r? A1::;:?
,
NOTE: LOCATION MAP MUST BE SUBl\1J.n'Jm WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SUR H if NT APPROVAL
Signature of Appli
IO\l.d~l
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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.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
~.,-
S~tJd Town Building Department
,___, TO: .
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED:
October 16, 2007
Transmitted herewith is a copy of application No. 3756 for a Cesspool/Septic Tank ALTERATION
Permit snbmitted by:
Mark Schwartz for ROl!er & Maureen Best
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 fonn 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: Maintain required setbacks from adiacent wells, buildings. propertv lines and water
Bodies. EXCA VA nON INSPECTION RE UIRED.
"'
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Signature
It) ~a- h
Dated I '"
.
.
l
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEIlOM OF INFORMATION OFFICER
'" Town Hall, 53095 Main It<
P.O. Box 1179
Southold, New York 119'/
Fax (631) 765-6145
Telephone (631) 765-180
sou tholdtown, northfork. n
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD W ASTEW ATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $1 oX or Non-Residential @ $25 _
Application No. 37:) b
Permit No.
)tf4-r- K J21/vvA7ViL--
Applicant Mailing Address Po 6(') K. 9'.J J
CI/TC-fh;& C/F
Septic Tank_Of Cesspool_ '
Brief Description of Pro posed Construction Of Alteration Ale CA-I f"/E-.P 72c /j./ll:..A'1
Applicant Name
/ /9 3)~
Location of Proposed Construc . on! Alteration:
Owner of Property: O(;[:IL d /it/lv.lE t5EF
Owner Mailing Addre:]1 ~ ~ ~ n ~~.J' . '(j Ai b ~
_L,_(~';'JJ~G,V1 23/J>S-
Owner Property Address: '~)() ~~e~rC l f C~~
-[O(1( _i;;)_A.J ~ J I__
Name and phone number of contact person J1"1.e.JC- SC filA//! ItT L 7.J1--~ / ;- J-
Tax Map No: Section 70 Block /3 Lot Z I). / i
Cross Street F I AI IZ J7Z-t:E )t4:7 A1::?
,
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SUR NT APPROVAL
Received by:
Signature of Appli
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(EXISTING)
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ADDITION
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GARAGE
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REMOVE EXISTING SEPTIC SYSTEM 1
j INST ALL'I :1
(1) 2000 SEPTIC TANK
(2) g' OIA. 4' OEEP DISTRIBUTION POOLS
(4) g' DIA.. 4' DEEP LEACHING POOLS
(3) g' DIA.. +' DEEP EXPANSION POOLS
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'PROPOSED NOTE 1
WATER METER . CBANGE(S)
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~ ~/' ......, ,..., ......v./"TI~rl1 I rV'lrr J.t.. .11'1 ;\NU UU I OF THE JOB SITE - DO NOT DRIVE OYER
UNCLEARED AREAS. PROTECT UNCLEARED AREAS WITH SNOW FENCING OR OTHER
BARRIERS. PLACE BARRIERS AROUNO THE DRIP-LINE OF TREES TO PREVENT INJURY
TO THE ROOT SYSTEM. IF A PERMANENT DRIVE CAN NOT BE INSTALLED BEFORE
CONSTRUCTION BEGINS. A TEMPOARY GRAVEL DRIVEWAY SHOULD BE INSTALLED
WHERE VEHICLES ENTER THE JOB SITE.
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WATER METER
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Abandonment 0 eXIstJn3 S:iIlt.:~ :, ::.:-:; mus& c tn
comfonnancc with dC;:;:'"lment rt::;'!irement Submit
completed form WWM. 0 go ::s Pl'oof.
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SITE PLAN
SCALE: I" = 20'-0'
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
PERMIT FOR ApPROVAL OF CONSTRUCTION FOR A
SINGLE FAMILY RESIDENCE ONLY
DATE
ApPROVED
FOR MAXlMU OF
EXPIRES THREE YE
/Zto -07 -{)o5'1
BEDROOM'
FROM DATE OF APPROVAL
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I'bIIBMtTARY &'tlrt.
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DRAWN: MH/MS
SCALE: I" = 20'
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Date: 10/15/07
Transaction(s):
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
Reference
Cash
Septic Permit- Construct - Resid.
Total Paid:
Name: Schwartz, Mark
POBox 933
Cutchogue, NY 11935
3756
5
Subtotal
$10.00
$10.00
Clerk ID: BONNIED Internal 10: 3756