The URL can be used to link to this page

Home My WebLink AboutSouthold Park District OV S0UTy0l ELIZABETH A.NEVILLE,RMC, CMC h O Town Hall,53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS H ae Southold, New York 11971 MARRIAGE OFFICER • h0 Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800 FREEDOM OF INFORMATION OF C ER omm, southoldtown.northfork.net VC� 0dC� D OFFICE OF THE TOWN CLERK po11c0�Ppyt2��009 TOWN OF SOUTHOLD TOWN oF'3DU.%[dd Town uilding Department FROM: Carol Hydell, Southold Town Clerk's Office DATED: February 9, 2009 Transmitted herewith is a copy of application No. 3856NR for a Cesspool/Septic Tank Construction Permit submitted by: Garrett Strang for Southold Park District 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. I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE 40, Comments: Signature Dated ELIZABETH A.NEVILLE " h�' `�* Town Hall, 69096 Main Roo TOWN CLERIC P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER Fax (691) 766-6146 RECORDS MANAGEMENT OFFICER y�fo 0� Telephone (691) 766-1800 FREEDOM OF INFORMATION OFFICER 1 ( southoldtown.northfork.ne! OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Ap Residential @$10 or Non-Residential @$25 ✓ plication Pennit No. Applicant Name_ �A,r4 +y 7-- »!5; F I/Lo f i TiE Applicant Mailing Address �. /Sp ,c / 4-17 Septic Tank—or Cesspool Brief Description of proposed Construction or Alteration 1�SToz �>£ /fie sCTd"" S2 l>/c- 74.�k e, Grr�rGu/ �s /f`s�s Location of Proposed Construction/Alteration: Owner of Property: Owner Mailing Address: Owner Property Address: �/ 2- Name and phone number of contact person Tax Map No: Section 40 5� Block d�_ Lot Cross Street NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEYWIT HEALTH DEPARTMENT APPROVAL guature of Applicant Date Received liy Yh V.x did4� S30t�a3S dilw"Ii 'C� c'p I l .SUYYOILS county De parcmen:,c'1[a�.�'u. ., ic::.. I/Z Approval for Construction-O6.zer Tuan Single 1^ea�muY Reference No. (f(o -0 7-God 7 Design Flow `f Use(s) ------ cOn f"nwce with S These plana have been reviewed for general County Department of Health Services standards, relating to water supply and sewage disposal. Regardless of any omissiono, inconsistencies or lack of detail, construction is required p is in accordance with the attached permit conditions and applicable standards,unless specifically waived by the Department. This approval expires 3 years from the approval date,unless extended or renewed. 2/Z/ei9' --e„ue� Approval Date EXCAVATION INSPECTION REQUIRED FOR SANITARY SYSTEM BY HEALTH DEPARTMENT Approved ir. 1triidanc. rt' a>....., tl deter-n nateo,i �. F�fr THS LOCITIOu .._:..- _ -f.;P L.� tug scALr- - - ....� .._ 1•`1---a8 KE�.ISsi1� .`fg SG.I1 Ml�S-,. r P S r P ,4e�o Ij 00 lilt 39 o . ii x Y� f SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4407-N Residential Non-Residential X Fee $ 25.00 New Existing X Name Of Owner SOUTHOLD PARK DISTRICT - - - ------------------------------ Mailing Address 1 P O BOX 959 uv) ------------------------------ Mailing Address 2 ------------------------------ $o��.-...cid `�a1r�- ; City St Zip SOUTHOLD NY 11971-0000 -------------------- -- ---------- Property Address 1 1025 TERRY LANE -7 OCA Property Address 2 ------------------------------ City St Zip SOUTHOLD NY 11971-0000 -------------------- -- ---------- Owner Telephone No. 631-765-6019 ------------ Tax Map No. section 65.00 block 1 lot 19.001 ------ --- ------ Cross Street HOBART ------------------------------ ---------------------------------- Issue Date: 12/24/09 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) ELIZABETH A.NEVILLE h`Z`� �G.y Town Hall, 53095 Main Road TOWN CLERK C2 P.O. Box 1179 H 2 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �'� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $10 or Non-Residential @$25 ✓ Application No. Permit No. Owner Name Owner Mailing Address P 0 G cc' SO L&- o UL M�l \kc l 1 Owner Property Address I 0 a<- Te Ec l ( o N-Q- So l i`i-�o l� �J9 \Ic11 t Owner Telephone No. to O lq- Tax Map No: Section Block I Lot 1q .001 Cross Street l-hj ��t ko("_d, Please check each that applies: New Construction / Alteration to Existing Systemy / Residential Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SCHD approval.) lsL�c out c� P- I 0 Signature of Applicant Date Received by: ) A 0