HomeMy WebLinkAboutLipik, Michael
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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
TO:
Southold Town Building Department
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD 11101 ~ _~L.r~JJLJl ~ 1
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FROM:
Carol Hydell, Southold Town Clerk's Office
DATED:
March 11, 2008
Transmitted herewith is a copy of application No 3788
Permit submitted by:
for a Cesspool/Septic Tank ALTERATION
Vicki Toth for Michael Lipik
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and ifthis office may issue the permit.
Please complete the form below and return it to me.
Carol Hydell
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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
Comments: Maintain required setbacks from adiacent wells, buildings, propertv lines and water
Bodies.
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Dated /
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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
6outholdtown.northfork.net
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ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MABRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
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.3 788
Permit No.
Applicant Name U I c..kl To-r?--..
Applicant Mailing Address i.(c;( S-:JaC 0 b -S V1
~u.-flu/d AJy //97/ .
Septic Tank-X-or CesspooI_ ,
Brief Description of Proposed Construction or Alteration Mw Si{J;b C-, <' r r ./em
Location of Proposed Construction/Alteration:
Owner ofProperty:-1\A J' rIA a ~( L, 'f) I t.
Owner Mai1ing Address: .. 6~Ci'nd ftytf
_pgr~::/,~~e IIY
Owner Property Address5>fo t r. {( 0 U
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Name and phone number ofco~tact person LJ I r lW 7O-tA O?dS- <9,;)-(9
Tax Map No: Section 1/ () Block .2 Lot dO
Cross Street ~ V\.<!.-W oorl R'
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SUR~~TH HEALTH DEPARTMENT APPROVAL
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/~J \ Signature of Applicant Date
Received by: \ (J. \.) \r 3 hI \\)f6
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HEALTH SERVICES
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SURVEY OF PROPERTY
A T FLEETS NECK
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. y:
1000-110-02-20
SCALE: 1"=30'
FEBRUARY 5, 2007
Fob. 14. 2007 (rebars sell
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AAEA-21,187 SO. FT.
LOT NUMBERS REFER TO "MAP OF EASTWOOD ESTA TES
SECnON TWO" FILED IN THE SUFFOLK COUNTY CLERK'S
OFFICE ON NOVEMBER 30, 1964 AS FILE NO. 4210.
ANY ALTERAnON OR ADDInON TO THIS SURVEY IS A lAaAnON
OF SECnON 72090F THE NEW YORK STATE: EDUCAnON LAW.
EXCEPT AS PER SECnON 7209-SUBDlIASlON 2. ALL CCRTtF1CA nONS
HEREON ARE VAUD FOR THIS NAP AND COPIES THEREOF ONL Y IF
SAID NAP OR COPIES BEAR THE INPRE:SSED SEAL OF THE SURVEYOR
WHOSE SIGNA nJRE APPEARS HEREON.
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ECONIC SUR
(631) 765-5020
P. O. BOX 909
. =MONUMENT 1230 TRA VELER STREET
e=PIPE SOUTHOLD. N. Y. 11971
Suffolk Co. Depl d he"l\h Services
Office of Wa"iewciler Mgtm.
07-113
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