HomeMy WebLinkAboutHoman, KennethELIZABETH A. NEVILLE, RMC, CMC
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
Ma~RRIAGE 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
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
April 29, 2009
~/-APIt 30 2009
BLDG. DEPT.
__ TOWN OF SOUTHOLD
RE:
Cesspool Construction Application
Transmitted herewith is a copy of application No.
Permit submitted by:
Mark Schwartz
3872 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 b~
DISAPPROVE
Comments:
Signature
Datef~/
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATIgN OFFICER
...v~-r- . ~ - Tow~ oF sou*moL.
APPLICATION
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 ~or Non-Residential~$2$__ ApplicationNo36q/'2~
Permit No.
Applicant Name HAi~i~ ~_ ~.~-*~.--.~-- I~ ~
Applicant Mailing Addrcss ~)~ /~ _~3 C~7~l~l~
Septic Tank V~ or Cesspool
Brief Description of Proposed Construction or Alteration ~
Location of Proposed C~st_mction/Alteraio.~' ~ I]
OWner o f Property:~~t~~$~ ~;~
Owner Mailing Address:
Owner Property Address:
Name and phone nlnnber of contact person
Tax Map No: Section ~_~__
Cross Street
Block 0 / Lot ~/,,, ji~ 7
NOTE: LOCATION MAP MUST BE SUBMITTElr WiTH APPLICATION. NEW
CONSTRUCTION m~0ugm~s S~mVEY2I/T}I I~I~E~TME~P~.OV~L
Received by:f~~Applicar~
Date*
FOUND FOUND
//
i .~/
/
/
WOOD STAKE
FOUND
PIPE FOUN
FENCE
FouND
CONC. MON.
wOOD STAKE
~ / '~o ,;.~r
169.9~¥ E
MON.
~l oL~J
S 44'51'20" MAP ·
S 44"25 -E
FOUND
15'
RIGHT
poser
~IDE RIGHT OF
r~IDE
RIGHT OF WAY
N/o/F
FLORENCE ~IGKS
(FARM FIELD)