HomeMy WebLinkAboutSteele, WilliamELIZABETH A. NEVH J.E: 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.nor th fork.net
TO:
FROM:
DATED:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Carol Hydell, Southold Town Clerk's Office
April 23, 2009
BLOE DEPT.
TOWN Of SOUTHOLO
Transmitted herewith is a copy of application No. 3870
Permit submitted by:
for a Cesspool/Septic Tank Construction
William Steele
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 J
DISAPPROVE
Comments:
Signature
Dated g9 ~'/~~
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTI~ OF VITAL STATISTICS
MAKKIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFOKMATION OFFICER
.~.Town Hall, 63095 Main l:~a
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
so u tholdtown,northfork.ne!
OFFICE OF THE TOWN CLERI<
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 ~'or
Non-Residential ~ $25 _ _
Applicant Name ~ ~
Applicant Mailing Ad(h-ess
Application No~O
Pemfi! No.
Septic Tank / or Cesspool
B fi~f ~Description of Proposed C%nstmction or Alteration
Location of,Proposed Construction/Alteration:
Name and phone number of contact person (j.) ~ ~
Tax Map No: Section .5- ~. Block ~ Lot [ O
Cros street Co .e- T 'D
NOTE: LOCATION MAP MUST BE SUBMrrTED WITIt APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH 1t~1t DEPARTlVlENT APPROVAL
I STORY I STORY 2 STORY I STORY I STORY
DVEL LING DVELL IN~ DVELL ING
NO~:
1. S~ ~ING P~ FOR PROPOSED
r ~ ~ ~ ~ t ~mc~ ~ O~ NOT SHO~.
, ~'
7.80
/
t' ~ ~ % CFFT~L ~Vf ~"~-- ~RES THREE YEARS FROM D~TE OF APPROVAL
P~CT NAME ~A~I~ TITLE 5UP~COU~T~M~ EOB~ET A. 5TE~ SCALE ~ATE ~G* NO.
STEELE ~ESIDENCE ADDITION DANITA~Y F~N ~,~, ,~ FRO~E5510NAL ENG;NEE~
F~ONT OF HOUDE ALTerNATE ~,~,o~.~ 2~ AOLLING AVENUE ~ ~HOWN ~. I A
I ~95 LEMON DELVE 5OUTHOLD, NY I