HomeMy WebLinkAboutRussell, Kim
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Town Hall, 53095 Main lWad
P.O. Box 1179
Southold, New York 11971
Fax (631) 766-6145
Te~phone(631)765-1800
southoldtown.northfork.net
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFiCER
TO:
Southold Town Building Department
FROM:
Michelle Martocchia, Southold Town Clerk's Office
DATED:
November 27, 2007
Transmitted herewith is a copy of application No. 3764 for a Cesspool/Septic Tank Construction
Permit submitted by:
Kim Russell
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.
Michelle L. Martocchia
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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
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Dated I I
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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
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ELIZABETH 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
SOUTH OLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential@$1O./' or Non-Residential@$25_
Application No37~ ~
Permit No.
Applicant Name K(M ~lA.. 0S1rCl
Applicant Mailing AddIess ~ q 5' JJo, l\wl. V .{\ r.
["aUVd-l. IJ Y /lq~ t
Septic Tank_or Cesspool ../ ' J
Brief Description of Proposed Construction or Alteration IJ Q,W ~ 0 {(A ("
Name and phone number of contact person
Tax Map No: Section S -5
Lau.VdL /Wry.
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
~~
Signature of Applicant
Location of Proposed Construction/Alteration:
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Block 01 Lot O~
Owner of Property:
Owner Mailing AddIess:
Owner Property AddIess:
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Cross Street
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Date
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SURVEY' OF
LOT 6
SUBDIVISION MAP OF
LONG POND ESTATES SEC. I
,., F/LEDDEC.2~l9" F/LENo.8037
AT ::fOOTHOLD
TOWN OF SOUTHOLD
SUFFOLK COUNTY N.r.
1000- ~~-:- 07- O~
SCAL E 1"= 40'
APRIL 16, /987
Feb. 25, 2002
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LONG
CREEK DRIVE
VACANT
The localions 01 wells and cesspools
sho wn hereon are from !ield observalions
and or Irom dolo oblained Irom olhers.
I am iiliar with Ihe STANDARDS FOR APPROVAL
ANO CO STRUCTlON OF SUBSURFACE SEWAGE
DISPOS L SYSTEMS FOR SINGLE FAMIL Y RESIDENCES
and will "'ide by Ihe conditians sel forlh Iherein and on Ihe
permit /0 conslruel.
AREA := 36,832 -4 ft.
0( 0.8341 <<:t'tI to tieIiM
,TltiIN 011 ""'1&-TO 71fS $Ur~~t VKJLATICN
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, OII'f#lAlJJ,.~iiAL OF ~MviYM
g' ' LL Y TO CQlI'L Y WITH SAIJ, LAW THE ~'AL7'DfED BY'
I#.IST U8Ef).Y ANY AHP ALL ~ U A COPY
OF MID ~OR'S tAAI'. TERIIS SUCH AS TED' "'fIJ
, "TO-OATE" ARE NOT IN COWLJMICE WITH THE LAW.
EXCAVATION INSPECllON
FOR SANITARY8Y8~
"BY HEALTH DEPA' _
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~1NGLE FAMILY RESIDENCE ONLY A
DATE '1-/1/-0$ H REF.NO.&
APPROVED
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