HomeMy WebLinkAboutShack, John
ELIZABETH A. NEVILLE
TOWN CLERK
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765.6145
Telephone (631) 765.1800
southoldtown.northfork.net
REGISTRAR OF VITAL STATISTICS
. MARRIAGE OFFICER;:\
" RECORDS MANAGEMENT OFllrCER
fREEDOM OF INFORMATION ci~FICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO:
FROM:
Lynda M. Bohn, Southold Town Clerk's Office
DATED:
March 14,2008
Transmitted herewith is a copy of application No. 3789 for a Cesspool/Septic Tank Construction
Permit submitted by:
Robert Bassolino for John Shack
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.
Lynda M. Bohn
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I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
/
DISAPPROVE
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Dated I /
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
fv; ~~ p. OFFICE OF THE TOWN CLERK
rI/~ r7- TOWN OF SOUTHOLD
l{fi/ U l SOUTHOLD W ASTEWATERDISnucr
~ APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential@ $10 ~r Non-Residential@$25_
Application No3781
Permit No.
ApplicantName~PT Y~-:)'L.l No fZ-.A
Applicant Mailing Address ~ ~ -'S 5 Z L <t -r H ft J
.:t>A.Y~iOIZ i0 Y 1130.1
Septic Tank /"--or Cesspool_ "
Brief Description of Proposed Construction or Alteration ~f?U I LO -4 ~j--..IO
t?:f.{~T1Hf f pjvt~y 12t?5i N fZw ~f?:rpC SY5TP;:fr-
Location of Proposed Construction! Alteration:
Owner of Property: ,\~i0 ~ .Jt-
Owner Mailing Address: l # PL--~5f4.JT
W ct:vt? Iv I M;5. ";;:5
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Owner Property Address: ~ e::
5,
0160 \
Name and phone number of contact person~ /-.J
Tax Map No: Section 47 Block
Cross Street --SlL'Vf?p M/I~iZ- f3'.fJ
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH AL TH DEP ARTMENT APPROVAL
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2 Lot 26 ~ t
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. _._/:/~~7 ~~ignature of pp icant
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Date
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TEST BORING
b, McOoflold Geoscience
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FLOOD ZONES FROM FIRM
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t/'~~.;ug: ~ ~r:r: ?'6Rll'tTJURVEY IS A VIOLATION
E:XCEPT AS PER SECTION 7209-~~ E1f/.fA ltltrl-8'r1ONS
HE:RE:ON ARE VALD FOR THIS MAP AND COPEs THERE:OF ONL Y IF
SAID MAP OR CoPES BEAR THE IMPREsseo EAL OF THE: SURVEYOR
WHOSE SIGNA TURE: APPEARS HEREON,.
AOOITiONALL Y TO COAIPL Y WITH SAD LA W THE: TERM "AL TERED BY"
MUST BE USED BY ANY AND ALL SURVEYORS UTL/ZM A Copy
OF ANOTHER SURVE:YOR'S MAP. TERMS SUCH AS "INSPE:CTED' AND
"BROUGHT-TO-DA TE:" ARE NOT IN COMPI.JANcE WiTH THE .LAW.
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T1C TAN/( .Il ~ F . r" ----r- $.
- WA - -- t., .$AM) SI1 -tr - _1_
SEPTIC SYSTEM" \... ~ . r- ..J
CROSS SECTION ~ ," .J ,
. _ MAX "
1000 &01. SEPTIC TANI( \ "'~~' '.J El
2 L.EAOf!t~"..... tIS DEEP Y-, l~_ _ ',- It - 2B.3I
ABOK ~ WA7E1f " - J,_ _ _
at:tV"?!,.7l) ~ <We> ""AND . ~',,$A,Of> !P
BACICFU """ CEAN _ _ '\', .
SURVEY OFI;s
16, 17 & PI LOT 15
OF G!!EE/FORT SHOREs
- SECTION ONE - .
AJfE 29, 7950 FLE NO.' 7759
T GREENPORT ,
'N OF SOUTHOLD
OLK COUNT~ N. y.
7000 - 47 - 02~Plv26
'SCALE: 1" = 20'
SEPT. ~ 799S
JAR. 27, 2007 fPRop. AOOIT.}
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IU"OLK COUNTY DEPARTMENT 0' HEALTH SE'~E'-
PERMIT FOR A~PROVAL 0, CONSTRIICTION ~fw( I , .
PIO LO~IN~AMILY RESIDENCE ONLY AfA
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LOT COVERAGE
EXIS TlNG 2234. SOFT
2234/15746 = 14%
3284/15746 ;
A ~~~6n-'bein
comfonnence with department requirement Submit
completed fonn WWM. ty(iJ asproot:
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163/) 765 - 5
P. O. BOX 909
1230 TRA VELER
SOUTHOLO, N. Y. //97/
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