HomeMy WebLinkAboutStanton, PhilipELIZABETH 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
OFFICE OF THE TOWN CLERK
TOWN OFSOUTHOLD
TO:
FROM:
DATED: August 10, 2010
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 3971
Permit submitted by:
Kathrine McCoy for Philip & Jennifer Stanton
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
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.
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
Dated
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
~l~Residential @ $10 or [] Non-Residemiai ~ $25
Application No.. Permit No.
Applicant Name: '~[~F~'~
Applicant Mailing Address: ~.
Septic Tank [] or Cesspool []
Brief description of Propsed Construction or Alteration:
Owner of Property:
Owner Mailing Address:
Property Address:
Name and Telephone No. of Contact Person:
Tax Map No.: Section: ~ ~ Block:
Nearest Cross Street: ' ~
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SUR~P~TMENT APPROVAL.
Received by: C~ Siganture of Apph~ant0 (.~te (-~
OWNERS ENDORSEMENT
Jennifer Stanton, being duly sworn, deposes and says:
Philip Stanton, being duly sworn, deposes and says:
Weresideat //~ tef~'~-~/~$t~'d 5'~5~'. i/~L-~' , in the County of
We are the
and the State ~f~. ' ' ' Owners of the premises located at
845 Maple Avenue, Southold, New York. We hereby authorize Kathrine F. McCoy
Architect LLC to act as our agent to act on our behalf with regard to all permits
required for the above mentioned property.
~Signature
Signature
Sworn before me this q~ day of /~g3~' , ~tO
Notary Public
HOUSE
FF Elev 195'
CROSS SECTION OF
SANITARY SYSTEM
NTS
~ ~o'" ,°~oureeter
Certified on y to:
JenniFer Stanton
Philip Stanton
Found CM
0.45'S
022'E
c re
No* ~rte~ -
Found CM
0.46'S
Foun
162W