HomeMy WebLinkAboutWitzke, StevenELIZABETH A. NEVTLLE, RMC, CMC
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Tow~ Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.north fork.net
TO:
FROM:
DATED:
RE:
Carol Hydell, Southold Town Clerk's Office
September 21, 2010
Cesspool Construction Application
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building Department
Transmitted herewith is a copy of application No.
Permit submitted by:
Steven Witzke
3981 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 end lbcation map of the project cited above and make the following
recommendations:
APPROVE ~
DISAPPROVE
Comments: Final approval required bom the Suffolk County Health Department
Signature
REOISTBAR OF VITAL STATISTICS
I~ARRIA.GE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORA{ATIO!q OFFICER
P,O. Bo~ 1179
8outhold, NewYork 119',
Fax (631) 76§-6145
Telephone (661) 766-180
sou tholdtown.nortb, fork.n
OFFICE OF THE TOWN CLERK
TOWN O? SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
,APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TAHK
Rcsid6ntial (~ $I0 ~/ror Non-Residential (~ $25 __
Applicant Name
Application No. '~?~>/
Penuit No.
Applicant Mailing Address
Septic Tank.
Bric£Description of Proposed Cons(auction or Alteration
'~ .~"h,"7 t¥,oJ,, lt.,- t-.o...,.~ -'
Location of Proposed Construction/Alteration:
Owner of Properly: f~. ~t ,'- :c:c~
Owner Mailing Addross: .6g~. t.~,~.~
Owner Properly Addrcss: O, c~o t-c.,~,-.~
Name and phone number of contact person
TaxMapNo: [oo0 Section ~6, Block o.~ Lot O_,~
Cross Street ~'7 t4o....~
NOTE: LOCATION MAP MUST 'BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH ItEALTIt DEPARTMENT APPROVAL
l coiwl gr.
· Signature of Ap'~licant
*q I:zl / Io
Dato
I am familiar with the STANDARDS FOR APPROVAL
AND CONSTRUCTION OF SUBSURFACE SEWAGE -
and will abide by the condiOons set forth therein and on the ~1~ A T SOUTHOLD .'
'e.'"it"tO'.ca"st ct' \
' EOF EO D
~e I~O~ion of wells ond ce,spools shown he~eon ore
from field observations and or, from data obtained from others.
.
ANY'ALTERATION OR ADD/EON TO THIS ~URVEY IS ,A VIOLATION
OF SECTION 7209OF THE NEW YORK STATE EDUCATION. LAW.
EXCEPT ,AS PER SECTION 7209-SUBDIVISION 2. ,ALL OERTIFIC,ATIONS
HEREON ,ARE VAUD FOR THIS M~a AND COP/ES THEREOF ONLY IF
SAID MAP OR COP/ES BEAR THE IMPRESSED SEAL OF THE SUR~Y~t~
WHOSE SIGNATURE APPEARS HEREON.
'~' t~
EglSTING C~.~$POOL TO aE
EXlSENG (HOUSS GARAGE, PA
1,770 / t6,159 x I00=11.0~
PROPOSED (H~S~ GARA,
2,121 ,/ 16.159 x 100=13.1~
EX/STING HOUSE, GARAGE, AND SEPTIC SYSTEM
TO BE REMOVED.-
AREA=t6,159 SO. FT.
'PtCONIC
(631) 765=5020 FAX~,
765-1797
P.O. BOX 909
1250 TRAVELER STREET I