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Home My WebLink AboutHohn, Donald o��Of SOUlyol ELIZABETH A.NEVILLE,RMC,CMC l O Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS CO2 Southold, New York 11971 MARRIAGE OFFICER • �O Fax (631) 765-6145 RECORDS Telephone 31) 765-1800 FREEDOM OMANAGEMENT I FORMATION OFFICER OIyCQ�a �,� southo dtown.northfork net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD p ECE E TO: Southold Town Building Department D MAY - 3 2010 FROM: Carol Hydell, Southold Town Clerk's Office DATED: Aril 30, 2010 BLDG.DEPT, P TOWN OF SOUTUOLD RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 3945 for a Cesspool/Septic Tank Construction Permit submitted by: Donald J & Susan C. Hohn 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. Carol Hydell I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: Final approval required from the Suffolk County Health Department, Signature ?� K Dated , o�gUf FO,(;�co ELIZABETH A.NEVILLE � � 'Town Hall,68095 Main 13 TOWN CLERIC P.O. Box 1179 _ REGISTRAR.OF VITAL STATISTICS Southold, New York 119 MARRIAGE OFFICER Fax(881) 766-6146 RECORDS MANAGEMENT OFFICER Qy?fo �� Telephone (681) 786-181 FREEDOM OF INFORMATION OFFICER southoldtown.northfork,t OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 V or Non-Residential @$25 _ Application No. � Pennit No. Applicant Name IXIAGD I ttnd SUSIgtJ G NOffn! Applicant Mailing Address 246&t& 7 7 `I4�5ee1-E776 LX EAgi-mAgio , IVY II 9 Septic Tank . or Cesspool Brief Description of Proposed Construction or Alteration Location of Proposed Construction/Alteration: Owner of Property: 20og I) d "-b SImw C t-taHh! Owner Mailing Address: Z'tf 6h1441417.I6� Owner Property Address: rr�fd-�nL' GL�Z�eS 1Jk� EASE /LLA�p/.DiJ /`[ V It�.39 Name and phone number of contact person JW Tax Map No: Section _36'aR Block. Lot 2- Cross Cross Street .Im#wo `P, NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL Signature Signature of li ant Date Reeeived bT, TAT E OF HEALTH SERVICES D5 oL GTtu�a�v9iGT/�> PERMIT FOR APr:CO'iAL OF; CONSTRUCTION FOR A 3' SI?vGLe: RV,;:--y RESIDENCE ONLY - rn x` Pft6CkYN fWs DATE c r/ � E3.3 " �'`� D ./IJ/� O/�9 6x/ A ppROL's€;_ X0 2 Y iat E :UE a 07 13ECROOM5 ! EXPIRES THREE YEARS FROM GATE OF APPROVAL 17 , BAST 2�,� G/LL�TT� ZV DZ�E 4r4 /ODS BT71s'ST rk6/ D lK Vs m a �✓�vcq,dr) ,� � � (1�i�agvr) O Q 02 / G:39.27 75.0 ' ua5 /oo ao' z4.6 Y/�C.9,U�"... �f34•�.tJl 6gD L4 O 9G �/9LvV.tJ7 yi'�l.S�.0 c� q LE or C) 9 r * r a � y a36ss b '��armor a ob Go>• ✓�6 M.q o o�/f'l�o�lAt��i°,u�� P.O.Bcar f/s/G Locarrav• F,v� M,v,�/av To�,�o,� opo , ,y, jai-'•c�Az� Luyaewri�To.C'NR/4Tl�i�YGEe't'1NiYPtu/To¢o�OQC/4 Z000T /1/a¢T.5/Fr�t.CyC D•s'TE,�/�9/7 Zaa/ �iglBi/�'c6/O' SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4414-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner DONALD HOHN ------------------------------ a Mailing Address 1 22 SAMUELS PATH �'Z \ ------------------------------ Mailing Address 2 City St Zip MILLER PLACE NY 11764-0000 \ 0 -------------------- -- ---------- 2 Property Address 1 945 GILLETTE DRIVE ------------------------------ Property Address 2 ------------------------------ City St Zip EAST MARION NY 11539-0000 -------------------- -- ---------- Owner Telephone No. 631-885-0207 ------------ Tax Map No. section 38.00 block 3 lot 2.000 ------ --- ------ Cross Street MANOR ROAD ------------------------------ t ---------------------------------- Issue Date: 5/25/10 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) �O OG ELIZABETH A.NEVILLE yet Town Hall, 53095 Main Road TOWN CLERK W = P.O. Box 1179 REGISTRAR OF VITAL STATISTICS O Southold,New York 11971 MARRIAGE OFFICERy • �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER l �a0 Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 or Non-Residential @$25 Application No. I Permit No. .3 I S� Owner Name (J f>AIA Ink #N Owner Mailing Address Y4 t F LS P4%1J Jtil1� I.FtZ 19 /d6e 16- 117 14 Owner Property Address qq5 / L L , 771 Owner Telephone No. 631— y' 02-07 Tax Map No: Section ®y Block 3 Lot 7- 0 0 Cross Street M A A✓01- A-V Please check each that applies: New Construction Alteration to Existing System Residential it Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SCHD approval.) Signature of Applicant Date Received by: RAX -- J IM Y r;Int\ p9 R ,' • \ • s i^C nye to 10 R Cvt� Qt y IN I? ® a Lill N rHo c� d ® a rn PUP ;i>.jo IMS titFF IN y ! Ny N ' - r