HomeMy WebLinkAboutJuul-Nielsen, Carl & PatriciaELIZABETH A. NEVILLE, RMC, CMC
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
TO:
FROM:
DATED: October 22, 2008
RE:
Transmitted herewith is a copy of application No.
Permit submitted by:
,~,: ?_ 3 ,~,.', ,/i% OFFICE OF THE TOWN CLERK
i~,~ ' TOWN OF SOUTHOLD
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
Cesspool Construction Application
3833
fbi' a Cesspool/Septic Tank Construction
Mark Schwartz for Carl & Patricia Juul-Nielsen
Please review the application and location map and advise if this office may issue the permit.
Please complete the tbrm below and return it to me. Thank you.
I have reviewed the application and location map of the project cited above and make the following
recornmendations:
APPROVE J
DISAPPROVE
Comments:
Signature
Dated /~/~~
REOISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
REOORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
.~Town Hall, 53095 Main Ros
P.O. Box 1179
· Southold, NewYork 11971
Fax (631) 765-8145
Telephone (631) 765-1800'
so u thold town.nortlffork.nel
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 ~$25__
Applicant Mailing Address. fff 6~_~' q ~3
Septic Tat~ or Cesspool
Brief Description 6f Proposed Construction or Alteration
Permi! No.
Location of Proposed Constructio~VAlteration:
Owner of Property: '(A~-6 'p _~/~J~t ~./~' JO6,'/..
O~erMai~gAd&ess: II ~ f ~ ~ ~a~W
O~mer Prope~y Address: W~
Name m~d phone ntm~ber of contact perso~Zc J//-/t~.--,~fi~ WE- 7_r~/~
Cross S~eet ~ ~
NOTE: LOCATION ~ ~ST BE S~ED W~H ~PLICATION. NEW
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' . ~ ) Si~a~eof~phc~ --D~e'
,/UNDEVELOPED
PROPERTY
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ROAD
vv ~Z~ l' LOOp)
HOUSE
ST: 1S(~ GAL. SEPTIC TANK
LP; (2) · DIA X S' DEEP LEECHING POOL
£p: EXPANSION ~OOL
N,T.$, · · '. ' '.
SEP~C TANK
NOTE Ci-LtNCE(S)
,-,; by Dept. of t-,emh S~Mce$
........... 1, MD(ED SAND ,*~NO LO~
........... 1, HLXED SAND AND LON4
DEVELOPED
PROPERTY
SITE PLAN
TEST HOLE DATA
SCALE: 1" = 40'-0'
SCTM# 1000-111-03-14
~UFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
.;~. PERMITFoRAPPROVALOF CO;qSTRUCTION FORA
$.NGLE FAb,,LY ~E~ :~r, Ca :%',:D
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