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Home My WebLink AboutArena, David & SandralgLW~BETH A. NrEV'rt'.I~ 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 OFFICE OF THE TOWN CLERK MAY 20 2010 BLDG. DEPT. TOWN OF SOUTHOLD TOWN OF SOUTI~ TO: Southold Town Building Department FROM: Carol Hydell, Southold Town Clerk's Offio DATED: May 19, 2010 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 3954 for a Cesspool/Septic Tank Construction Permit submitted by: Thomas C Samuels for David & Sandra Arena 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 Count3' Health Depa~hnent, ELIZABETH A. NEVILLE 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 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION Residential @ $10 .. CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK / ~./or Non-Residential ~ $25 __ Application No, --~ Permit No. Applicant Name Applicant Mailing Ad&ess Septic Tank V' or Cesspool__ Brief Description o f Proposed Construction or Alteration ~¢cmoua. P.,/~a~,don. ane. t.~ Location of Proposed Construction/Alteration: OwnerofProperty: ~;~t./J)~/ '~ ~t4t~/,-t~, Owner Mailing Address: ,- "f'n/(o 7"~OM t'G ~d 0-7- 6 ( Owner Property Ad&ess: / ~O/~ /V'e_~,,o ,oQ.r, ,~o-~ .247._Ao../a. Name and phone number of contact person '~_D-'/~ ~'~/~4M~to~(.~d Tax Map No: Section /t~7 Block ~(a Lot Cross Street ~ 6I.~L~ Cd NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH 1TEALTH DEPARTMENT APPROVAL Signat/are of Applicant Date Received by: ~1~::~ LII~ ~! ~/ATION 2.8,.0 It. ~ ~ LINE PI ~aTION i4.1 ~. ~ ~I'HI~='~. , ~I'HIN. 2'H~ X. I/~ "~. . · ~IG m°'-°"/I ~'-o" / ~' ~,~ SEPTIC PROFILE RESIDENCE (N.T.S.) NEY~ ~UFFc N~I ~I'-It~::~1 N~, T PUBLIG