HomeMy WebLinkAboutPurita, Claudia
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREE.RQM,J).F INFORMATION OFFICER
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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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) I._ OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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Ll~:\'''!'j''OF SC~JTHiJLD -,
TO: Southold Town Building Department
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED:
July 3, 2008
Transmitted herewith is a copy of application No. 3813 for a Cesspool/Septic Tank Construction
Permit submitted by:
Claudia Purita
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.
Linda 1. Cooper
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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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Comments:
Signature ~ ft
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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
southoldtown.northfork.net
..
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
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential@$IO_ or Non-Residential @ $25 ~
Application No. 3Sl ')
Permit No.
Applicant Name CI&U &J 0-- 'f1~
Applicant Mailing Address jq9q)" Sn \wDU\P..uJ /hNL
50~& , f'J'P /197 (
Septic Tank..)(.or Cesspool_ ...
Brief Description of Proposed Construction or Alteration....}jeMJ Wl~
W~ \.\~W ~(o.~~ 'ii.~
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Location of Proposed Construction/Alteration:
Owner of Property: Cl~'o...... <j11.Yl~
Owner Mailing Address: Jqqq:) ~UiQW A-vZ
SD~,NY /117/
Owner Property Address: /'11JO Sc0nJJjieAAJ .A-ve
>'O\i:tN~.u& .' t'0'( II q7 (
cj~l1.l.i(L ?\.l~
Block 3
A
7(p)'-4909
Lot <1. J)
Name ana phone number of contact person
Tax Map No: 1000 Section...21
Cross Street C~bJ;-s' ~
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
8lJ/jk ~
Signature of Applicant
Received by;ill2- L,
Date
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SITE
SCTM # 10(
PROPERTY: 191
ADRESS Sou
OWNER: Cia
19S
Sol
SITE: DEVELOPM
DEVELOPM
TOTAL SITE
ZONING: AC
SURVEYOR: Peet
POI
1230
Sout
LICE
TEST HOl
NO SCALE
TEST HOLE DATA 101:
0.5 BROWN LOAM
3FT.
PALE B 0
PALE BROWN SI
WITH 10% GRAY
8FT.
BROWN FINE TC
NO GROUNDWA'
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Suffolk County Deportment of Health Services
Approvll1 for Construction-Other Than Single Family
ilrence~.O ....O~-()O/1 DesignF1OW~. .
::~lanshavet:nrevl~ efc1rtl'(~s
nty Department of He Services standards. relating to wa r
ply and sewage disposal. Regardless of any omissions.
'r.sistencies or lack of detail. construction is required to be in
lrdance with the attached Jls1'Dlit eonditiuns and applicable
IClarda,lIil1ilss sjleCllical!y waived lIy t.he Departllitllt. This apprOVal
~. 8 )III" ftolll t.hs IIW~te, W1Iee. extelld~ewec1.:
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Approval Date Reviewer
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C!t'nuC! C!llaalllC>C>I^""
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CHECKED BY:
UT
NS
DATE:
OCTOBER 15 2007
SCALE:
1" = 20'.0"
SHEET TITLE:
SITE
UTILITIES
PLAN
SHEET NO.:
2