HomeMy WebLinkAboutLicalzi, Luke & RitaELIZABETH A. NEVII,LF.: 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 TIlE TOWN CLER]-
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Carol Hydell, Southold Town Clerk's Office
DATED: September 9, 2010
SEP 9 2010
BLDG. DEP]'.
TOWN OF SOUII~OID
RE:
Cesspool Construction Application
Transmitted herewith is a copy of application No. 3978 for a Cesspool/Septic Tank Construction
Permit submitted by:
Thomas C Samuels for Luke & Rita Licalzi
Please review thc application and location map and advise if this office may issue the permit.
Please complete the form below and remm it to me. Thank you.
Carol Hydell
I have reviewed the application and/lpcation map of the project cited above and make the following
recommendations: o~
APPROVE
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
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
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 / or Non-Residential ~ $25 __
Application No. ~ 9 7~)
Permit No.
Applicant Mailing Address
S~tic T~ + or Cesspool
BfiefDeschpfion ofProposed Cons~ction or Alteration
~c~ion of Proposed Cons~ctio~Alteration:
O~or M~ling Ad.ess: fi?
~ ~d phon~ ~r of ~on~t p~o~
V~ mp ~o:/~ S~tion 7~ U~k ~ ~t ¢6. /
NOTE: LOCATION ~ ~ST BE SUBMI~ED WlT~ ~PLICATION. NEW
CONSTRUCTION ~QUI~S SURLY ~T~ ~E~T~ DEP~T~NT APPROV~
Received by:
Sign~r'-'~ o f Applicant
SEPTIC PROFILE RESIDENC~E~
(N.T.S.)
I
:._ _, -.. _SITE DATA ~1~o,
SCTI # 1000-7~46.1
PROPERTY: 2109 CALVES NECK ROAD
ADDRESS SOUTHOLD, NY
OWNER: LUKE & RITA UCAIJ~
19 PROSPECT AVEHUE, GARDEN CITY, N~
SITE: 58,518.87 sf = 1.343 ac
ZONING: R-40
SURVEYOR: Nathan TaR Corwin III
PO BOX 1931 i.u
-EXI~TIN~ C, OflC, RIVERHEAD, NY 1190J
~ Ucense # S0467
Dated SEPTEMBER 22, 2004
LOCATION MAP
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~ SITE PLAN
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BMISSlON
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