HomeMy WebLinkAboutPalillo, DianeFJ.TT.Z~BETH A. NEVIT.!.~., RMC, CMC
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hail, 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:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
November 24, 2008
t.. T~O_WN O~$(~L!THOLO. ~
RE:
Cesspool Construction Application
Transmitted herewith is a copy of application No. 3840 for a Cesspool/Septic Tank Construction
Permit submitted by:
Robert Barratt PE for Frank & Diane PaliHo
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.
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE ~
DISAPPROVE
Comments:
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTt~ 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
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
Residential ~ $10 ~,t or Non-Residential ~ $25 __
Applicant Name ~G~.~,R~' l~ ~.~. A'tT
Applicant Mailing Address ~ q ~ V ~ ~ ~o~
Septic T~ ~ or Cesspool
Brief Deschption of Proposed Construction or Alteration
P~
Application No.S ~
Permit No.
Location of Proposed Construction/Alteration:
,~-'rHot..b /,ay tt o,-'t !
Owner of Property:
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person
Tax Map No: Section ~
Cross Street l~llJ ~ ~'~J R,~ ~ I~
Block ~ Lot ~, I
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Received by:
'./~ ~ ~T,'~ ',
Signature of Applicant
Date
N 85'58'30"
SURVEY OF PROPERTY
SITUATE
SOUTHOLD
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C, TAX No. 1000-59-06-5.1
SCALE 1"--50'
APRIL 8, 2008
%.
Nathan Taft Gorwin III
Land