HomeMy WebLinkAboutPezzino, Peter & SabrinaELIZABETH 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:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
September 2, 2009
SFP - 4 2009
BLDG. DEP~
TOWNOFSOUTHOLD
Transmitted herewith is a copy of application No. 3897 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Patricia Moore for Peter & Sabrina Pezzino
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. Thank you
Carol Hydell
I have reviewed the application and loc~.ation map
recommendations: ~ of the project cited above and make the following
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings, property lines and water
Bodies. EXCA~VATION INSPECTION REQUIRED.
Dated
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
~ECORDS M~AGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CT,~,,P,I/
TOWN OF SOUTHOLD
S~)UTI:IOLD WASTEWATER DISTRICT
APPLICATION
To. wn Hall, 53095 Main Road
P.O. Box 1179
Southold, New Yo~k 11971
Fax (631) 765-6145:
Telephone (631) 765-1800
southoldtown.northfork.net
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEFrlC TANK
Residential ~ $10
Non-Residential @ $25
Application No. 5 ~C~ 7
Permit No.
Applicant Name ~ C/~0 ~
Applicant Mailing Address ,.~.02v"> ,~fiZ,'~/~ ~O~O~/ ~f~)/"~5/C~/
&
S~tic Tank or Cesspool ~
Brief Des~pfion of ~opbs~ Co~cfion or ~t~afion
Location of Proposed Constxuction/Alteration:
Ow.erofprope.y: '
Owner Mailing Address:
Owner Property Address: ~-~4:y~ iA/0/~ /
Name and phone nmb? of contact person
Tax Map No: Section //0 Block '~' Lot '7
Cross Street ~t~/t, r.~5 ~__.~o&4
NOTE: LOCATION MAP MUST BE SUBMITTED wrrH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVE~APPROVAL.
Signature o~"t~pplicant
Received by:
TEST HOLE -~
BY MCDONALD
GEOSCIENCE :.
6/E6/OB ~
~L
LOAM
· OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW.
EXCEPT AS PER SECTION 7209 ~ SUBDIVISION 2. ALL (~ERTIFICA TIONS
HEREON ARE VALID FOR. THIS MAP AND COPIES THEREOF O~L Y IF
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR.
WHOSE SIGNA TURE~APPEARS HEREON.
AREA = B, 751 sq. ft.
BLEVA TIONS & CONTOUR LINES ARE REFERENCEb .TO N.G.V.D.
FLO00 ZONES FROM REM -
MA~ NUMbeR $6103C0501 G Me.v 4~1998
I ~n fam#iar wllh lhe STANDARDS FOR. APPROVAL
AND CONSTRUCTION OF SUBSURFACE SEWAGE
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
and will abide by the conditions sel forfll therein and on lhe
permff Io construcL
~ ~, ,z -~ , The Iocol/ons of. wells~ ~nd cesspools
~ L ~ ~· ~L tO - shown hereon ore ~om. field ohservalions
and or from data ~d /rom' other~'. '
JOS~H FIS~ET~I. P.E. . [ ,*/ / ~L~ENCEo~Y [
__~ ~-~ .
w SUF
, ~ ~ T ~E. FOLK
,
. , ,, ,; T'O WN OF SOUTHOL. D
· ~ , ~ ~ ~ ~/ SUFFOLK COUNTY, N.Y..
,, _.~/ /ooq . J/O ~ ~8'- o7
~-" .< k~ . I . OCT. /~-~007
N/O/~O~ / / ~ N/O/ / MAy 28, 2008 (FLOOD ZONES ~ SPOT ELs.
~l~ " / ~
/" ' ~ ~R~
~ ~ ~ ~ ~UUI~ A~usr ~5, ~8 (LOT COVERAGE~
PE~ ~Z~O
~C~ ~TRACT~ ~C. .
~LITY NA TYONAL ~TLE ~~ C~PANY
S TREE T
SOUTHOLD, N.Y. 11971