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Home My WebLink AboutFHV, LLC OF SOUryol ELIZABETH A.NEVILLE,RMC, CMC O Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS y Nc Southold, New York 11971 MARRIAGE OFFICER :% • �O Fax(631) 765-6145 RECORDS FREEDOM OF MANAGEMENT �111FORMATION OFFICER l�CS southo dtown northfork.n, Telephone(631) et OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FO FROM: Linda J. Cooper, Southold Town Clerk's OfficeJUL DATED: July 16, 2010 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 3964 for a Cesspool/Septic Tank Construction Permit submitted by: FHV, LLC (a, 53345 Main Rd., Southold 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 to ation map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: Signature Dated o�gUFFOt;�co ELIZABETH A, NEVILLE �`Z �lj. Town Hall, 53096 Main R< TOWN CLERK t P.O. Box 1178 REGISTRAR OFVITA STATISTICS Southold,New York 1199 MARRIAGE OFFICER « Fax (631) 766-6146 RECORDS MANAGEMENT OFFICERfold Telephone (631) 766-180 FREEDOM OF INFORMATION OFFICER southoldtown.northfork,n OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT .l ' owl def APPLICATION ,All CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10_ or Non-Residential @$25X Application No. ��L e�f n Permit No. Applicant Name 1 6`1 LLC Applicant Mailing Address A A�44. 6 / /� Septic Tank . or Cesspool lJ Brief Description of Prosed Construction or Alterations 3Wrfrn+ GVmF+�" Location of Proposed Construction/Altera/tion: Owner of Property:_ /LLC Owner Mailing Address: e'd%k0_Pr Owner Property Address: 44 Name and phone number of contact person Tax Map No: Section Block / Lot Cross Street _L liy NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL Signature of AppliW ate Received by: 9 r SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4421-N Residential Non-Residential X Fee $ 25.00 New X Existing I i Name Of Owner FHV, LLC Mailing Address 1 P -O BOX 1295 ------------------------------ r(4\1 , L L C Mailing Address 2 ------------------------------ City St Zip . CUTCHOGUE NY 11935-0000 Property Address 1 53345 MAIN ROAD ------------------------------ Property Address 2 ------------------------------ City St Zip SOUTHOLD NY 11971-0000 -------------------- -- ---------- Owner Telephone No. 631-734-6429 ------------ Tax Map No. section 61,600 block 10 lot 13.001 ------ --- ------ Cross Street HORTON'S LANE ------------------------------ ---------------------------------- Issue Date: 9/20/10Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) •' O��SUFfO�,�c � oG ELIZABETH A.NEVILLE Town Hall, 53095 Main Road TOWN CLERK C _ P.O. Box 1179 REGISTRAR OF VITAL STATISTICS O Southold, New York 11971 MARRIAGE OFFICER A'i* • O�� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �l �a 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. �f Permit No. Owner Name lWI zu— Owner Mailing Address Owner Property Address .7 /`�� /Vii //�-7/ Owner Telephone No. /-?y J cy Tax Map No: Section 61, 01 Block 1 Lot 13, 001 Cross Street Please check each that applies: New Construction Alteration to Existing System 2C Residential Non-Resi ential 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 pp nt to - Received by: ' K ®��OF SOUTH®� ELIZABETH A.NEVILLE,RMC,CMC ® Town Hall, 53095 Main Road TOWN CLERK P.O.Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICER a� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ®��/ Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER Comm southoldtown.northfork.net OFFICE OF THE 'TOWN CLERK TOWN OF SOUTHOLD August 13,2010 FHV, LLC ---P O-Box'1-295 Cutchogue,NY 11935 RE: 1000-61.1-1-13.1 Dear Sirs: Enclosed herewith is the Construction,Alteration or Modification Permit for a Septic Tank/Cesspool System for which you applied. AFTER the system is installed but prior to being used, an OPERATION PERMIT IS REQUIRED. The operation Permit is issued by the Southold Town Clerk's Office. The fee is Ten Dollars ($10.00) for a residential system and twenty-five dollars ($25.00) for a non- residential system. Your check sho pe payable to the "Southold Town Clerk". An application form is enclosed. lease a requested information and return the application, proper fee,, LOCATI '(kap must indicate the location of the cesspool(s)/septic tank(s), ving approxan s in feet from any buildings to the pools and distances between the poo Should you have any questions con rning this matter, please do not hesitate to contact this office. Very truly yours J.j Carol Hydell. Account Clerk Enclosures 47