HomeMy WebLinkAboutGatanas, JohnEI,I~4J~ETH A. NE~II,~,~.~ 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:
RE:
Carol Hydell, Southold Town Clerk's Office
June 22, 2009
Cesspool Construction Application
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building JUN
Depath~ient 2 3 ~[~J' ~
BLDO. DEPT
~N OF SOU~OtO
Transmitted herewith is a copy of application No.
Permit submitted by:.
Erie Nielsen for John GstgnAn
3881 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: ~__
Sign;tur~
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 or [] Non-Residential ~ $25
^pplication No. ~ ~ ~ [
Applicant Name: ~
Applicant Mailing Address:
Septic Tank ~ Cesspool []
Permit No.
Brief description of Propsed Construction or Alt~ration: .~r~>
Location of Proposed Construction/Alteration:
Owner of Property: ---~4~o ~-~ d-r'~l~a tt~
Owner Mailing Address: ~/h'~" ~
.t~r'C i~v/t bate
Property Address:
Name and Telephone No. of Contact Person:
Tax Map No.:/'ooo Section: /o ~ Block: b~ Lot: 2~-~
Nearest
Cross
Street:
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY Wl'l'it HEALTH DEPARTMENT APPROVAL.
/Q}~/ Sigan-ture o'fApplieant / 'Date
Received by:
~ ~ -',~ , · A T MA TTITUCt~
el
TO ~N
OF
SOUTHOLD
· SUFFOLK COUNTY, N.Y.
~ ~ ~S~ ~ ~ ~ ~~ ~ ~ PUBuC w~ DECEMBER 19, 2007
~ ~ ~ ~ ~ ~ ~ ~ ~ D~UNG ~ PUBUC WA ~R SEPT. 30, ~00~
~ I~OC e~L CYL~L ~ r~ L~ ~ ~ ~ VACANT
OR RE~D ' ~ I
TEST HOLE DA TA
~cOONALD CEO.SCIENCE
FROM DkTE OF A. ppROVA~
THREE
YEARS
I am familiar with the STANDARDS FOR APPROVAL
AND CONSTRUCITON OF SUBSURFACE SEWAGE
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
and will abide by the conditions set forth therein and on the
permit to construct.
Elevations referenced to on assumed datum.
The location of wells and cesspools shown hereon ore
from field observations and or from data obtained from others.
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A HOLATION
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW.
EXCEPT AS PER SECTION 7209-SUBDIWSION 2. ALL CERTIfTCATIONS
HEREON ARE,VALID FOR THIS MAP AND COPIES THEREOF ONLY IF
SOlO ~AP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR
WI'lOSE SIGNATURE APPEARS HEREON.
AREA-lO,666 SO. FT.
CEJVTRAL DRIVE
_ _ 65.00'
90°00°
LOT 165
D~UJNG WITH PUBUC W.Ai'ER
LOT NUMBERS REFER TO BLOCK 12 MAP OF 'CAPTAIN
KIDD ESTATES" F7LED IN THE SUFFOLK COUNTY CLERK'S
OFFICE ON ,~4NUARY 19, 1949[ AS FILE NO. 1672.
LOT COVERAGE
HOU$£ 1659 sO. ft.
GARAGE 247 sq. lI.
DECK d STOOP 176 ~q. lt.
208Z $¢.i'.
2092! IO6G~ = 19.5~
LOT 156
LOT 16,1
VACAN~
(6JU
P.O.
12,.70 TR;
SOUTHOLD, N. K
NO. 4961~
765- 179 7
07-227