HomeMy WebLinkAboutPearlstein, AlixandraELIZABETH A. NEVILLE, RMC, CMC
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hail, 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
TO:
FROM:
DATED:
RE:
Southold Town Building Depa~ hnent
Carol Hydell, Southold Town Clerk's Office
August 31, 2010
Cesspool Construction Application
AUG 3 1 2010
BLDG. DEPT.
TOWN OF SOUTHOLO
Transmitted herewith is a copy of application No. 3975 for a Cesspool/Septic Tank Construction
Permit submitted by:
William Adams for Alixandra Pearlstein
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
iiatg~e?tm C~O~/O
EIJ~ABETH A. NEVi~E ':
TOWN CLERK
REOI~TRAR OF VITAL I~TAT~STICS
MARRIAGIE OFFICER
REOORDS MANAGEMEN~ OFFICER
FREEDOM OF INFOP, MATIO!~I OFFICER
P.O. Box 1179
Southold, NewY~rk 119
Fax (681) 755-6146
Telephone (681) 766-18(
sou tholdto~.no~ork.~
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10~or Non-Residential ~ $25 __
Applicant Name
Applicant Mailing Address ~
Septic Tank x Jot Cesspool
B ??9' t on P,o os d ¢ons ot on or ^Iteratio
Location of Proposed Construction/Alteration:
Owner Mailing Address:
Application No 0oq75'
Permit No.
Owner Property Address:./
Nme ~a phone nmb,r of mnmt pemon
T~MapNo: S~tion /~ , Block. / ~t ~ -
NOTE: ~CATION ~ ~ST'BE 8~D W~H ~PLICATION. ~W
CONSTRU~ION ~Q~8 8~ ~ ~ DE~T~ ~PROV~
~ Si~a~of~ph~t Da~
Received
mo.~EO ~' O~A. X ~' OeeP O~b~S FOR ~F ~"-OFF'rA~'''
LONG ISLAND
TEST HOLE DATA
EL='74.4'
HEALTH DEPT'. REP. #
RlO-10-OO2q
o
c
m
)EPART~E~'{T OF HEALTH ,~/1(~.
PERMIT FOR APPROVAL CF CONS'rRucTION ~A"
DATE
/
/
NO'I'E~,
EXPIRES THREE
· IvlobLIHENT
EXI~TIN~ C,E~E, POOL TO I~E
A5 l'~L-ie, 5.C,.~.H.5. 5TANDAP-P5
ELEVATION5 REF. NA'v~ '~, PATUM
A~ = -/4,14~ S. I~.
Ar'e,,m = I.-/O22
~RAPHIC, SC. ALE
59.77,'
6 EAST MAIN STREET N.Y.S. LIC. NO. 50202
RIVERHEAD, N.Y~ 11901 369-8288 Fax 369-8287
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