HomeMy WebLinkAboutDibona & Saraceni ELIZABETH A. NEV~,LE
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
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Resi'dential ~ $10 ~/ or Non-Residential ~ $25 __
Applicant Name
Application NoT~ ~ ~-
Permit No.
Applicant Mailing Address,
Septic Tank__~__or Cesspool (J '
BriefDesc~ption of Proposed Construction or Alteration
Location of Pr°posed ~onstruction/Altcration:
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact Per~;~ ~)~''4Alt'
Tax Map N~ Sectioo,
NOTE: LOCATION MAP MUST BE SUBMITTED wITH APPLICATION. N-EW
CONSTRUCTION REQUIRES SUR~i Yil WITH }iEALTIt DEPARTMENT APPROVAL
Signature ° f gp'pfii~t bate'
Received by:
ELIZABETH 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:
Carol Hydell, Southold Town Clerk's Office
March 19,2009
OFFICE OF THE TOWN CLERK
So mt
RE:
Cesspool Construction Application
Transmitted herewith is a copy Of application No. 3862
Permit submitted by:
Para Hunt for Dibona & Saraceni
for a Cesspool/Septic Tank Construction
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:
Signature
Dated
~ ~ ~ ' ' I ~0 C '. PAGe · . . '. '''*'''''~ SEAWOOD DRIVE
TEST HOLE DATA
EASEMENT
~P.EN SPACE
0
OPEN SPACE
EASEMENT
SITE PLAN
SCALE: 1" = 60'-0'
:----; --
~i FO :A) :)VAL SI IGt E
SUFFOLK COUNTY DEPARTMENT OI
PERMIT FOR APPROVAL OF CONSTRUCTION
SINGLE FA~,~ILY RESIDENCE AND
REVISIONS:
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