HomeMy WebLinkAboutCallis, Jerry
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
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TO:
FROM:
Southold!op Building Department
Carol Hydell, Southold Town Clerk's Office
DATED:
November 29,2007
RE:
Cesspool Construction Application
Transmitted herewith is a copy of application No. 3765 for a Cesspool/Septic Tank Construction
Permit submitted by:
Dr. Jerry J. Callis
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.
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I have reviewed the application and location map ofthe project cited above and make the following
recommendations: /"
APPROVE
DISAPPROVE
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Comments: ~~~~~~:~
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Signature
1;J-/o~h7
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
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 No.
Pennit No.
31~
Applicant Name ~~/2.tt. -r J . q..vL..lJ'
Applicant Mailing Address P, 0, BOy: 53 7
/ .>ou111 Of..T>.. f.!.:j. /l q 7/
Septic Tank v or CesspooL--
Brief Description of Proposed Construction or Alteration
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Location of Proposed Construction/Alteration:
Owner of Property: D (2... J6ll..R.,-( J, CMM S
Owner Mailing Address:_P [ () I ~O)(. :;37
SOOJlCOV\) , /'l' '1.
Owner Property Address: 1-.3S'O P Irf2..AOI se
So rJ17{ 0 /A) I }.J- 'I,
AlElI/<;e-pnc TfItN l~
((q7/
PoIPT
~AD
Name and phone number of contact person
Tax Map No: 1000 Section 91
Cross Street
NOTE: WCATION MAP MUST BE SUBl\11'lTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH ALTH DEPARTMENT APPROVAL
Block 3
Lot {'t.'}
Received b;W./l.
,.
Date
SURVEY OF PROPERTY
SITUATE. BAYVIEY-t
TO~t 5OUTHOLD
SUFFOLK COUNTY, NY
SURVEYED 08-25-2001
SUFFOLK COUNTY TAX #
1000 - 81 - OB - IGloB
CERTIIFIIIED roo
JERRY J. CAlLlLIS
Test Hole
McDonald
0eoscience
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KEY MAP N.T.S.
ExCAVATION INSPECT ON REQUIRED
FOR SANITARY S~M
BYHrALTH DlP
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17'
NOTES,
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280.67'
L,.I.,ICI ~ OR FORMERLY' Of',
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MONUMENT FOUND
ELEVATIONS REF. N6YD '2"1 DATUM
AAfA = 154,42B Sq. Ft. OR B.54!51 AGree
6RAPH1C. sc.ALE 1"= 100'
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OF HEALTH SEIIVICES
PEIIIIIT Foil APP VAL OF NSTRUCTION FOR A
SINGLE FAMILY RESIDENCE ONLY
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NO V'lELLS IN AREA)
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NO V'U:LL5 It'{ITHIN
ISO' OF PROP. SEPTIC
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Abandonment of existing sanitary system must be in
comfonnance with f1epartrnent requiremenl Submit
Jeted fonn WWM. tn:(; as proof.
DATI & H.
"PPIlOVED
FORM
EXPIRES THR
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e-10,0"1- CJ (,-z-.-
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LAND NelI1 OR l"QRHERLY OF.
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DONAlD F. LAYl!NTHALL
F 1 BEDllooMS
E "S FROM DATE OF APPROVAL
_54'01 "B
1011.75'
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JOHN C. EHLERS LAND SURVEYOR
6 BAST MAIN STREBT N.Y.S. UC. NO, 50202
RlVBRHBAD, N.Y. 11901
369-8288 Fax 369-8287 REF. \\Compaqserver\pros\07\07-186a.pro
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