HomeMy WebLinkAboutBogart, BonnieELIZABETH 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.north fork. net
OFFICE OF THE TOWN CLERK
TOWN OF $OUTHOLD
TO:
FROM:
DATED: September 28, 2010
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No.
Pvmdt submitted by:
Bonnie Bogart
Southold Town Building Depa,h~ent
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 r~quired from the Suffolk Comat¥ Health Depa~hnent
Signature/
ELIZABETH A, NEVILLE '."
TOWN CLERK
RI/IGISTRAR OF VITAL STATISTIC~
MARKIAGE OFFICER
I~EOOP. DS LiANAGEMEN[~ OFFICER
FREEDOM OF INFORMATION OFFICER
..,Town Hall, 53095 Main lows
P.O. Box 1179
S6uthold, NewYork 11971
Fax (631) 765-0145
Telephone (631) 765-1800
sou ~holdtown,north~fork.ne!
Residential ~ $10 ~,. or
0F s°uT °LD
CONSTRUCTION or ~TE~TION PE~IT
CESSPOOL or SEPTIC T~K
Non-Residential ~ $25 ~ Application No.'~
Permit No.
App!icant Name ~k~ ~
Applican4 Mailing Address
Septic Tank ,~ or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: ,Cd~-~,
Owner Mailing Address: ?',
Owner Property Address:
Name m~d phone number of contact person
Tax Map No: Section ~ I
Cross Street C,N~ ~L4 ~ I ~}~ H
Block. Lot ;.-, ,.,
NOTE: LOCATION MAP MUST'BE SUBMITTED WITH APPLICATION, NEW
CONSTRUCTION REQUItLES SURVEY WIT~[IJiALqTH DEPART1VI~NT APPROVAL
//~ , Signature of Applicant k.~ Date
Ree.~ived IJy:
NT
APPnOVr:-D L'"/'~C~..q.~ _ ~,,.,,". ~ ,
FOR MA,~IMUI,~ OF t..] ('~ B~.DROOM$
IfACANT
SUFFOLK COUNTY DEPARTMENT OF HEALTH
PERMIT FOR APPROVAL OF CONSTRUCT~CN FOR A
~INGLG FAMILY };~ES[~NC,':: ONLY
EXPIRES THREE YEARS F~Oi~ DA~ OF A~"ROMAL
~ ~ tot (~ SURVEY OF PROPERTY
u A T SOUTHOLD
' ~ TO WN OF SOUTHOLD
'cLusrE~ ,~ su~v~ ~ ~or ~ . ~ .~: SUFFOL C~T~ N Y
~ED ~ T~ ~ ~ ~ S~FOLK
AND CON3TRUCTION OF SUBSURFACE
DtSPOSAk SYSTEMS FOR SINGLE FAMILY ~S~ENCES ~l' N 88'~'50~ ~
and wEI abide by lhe conditions sel forth lherein ~d the
~ VACANT
The Ioco/ions of wells ond ces~pool~
~how~ hereo, ore from field ~servetions
765 - / 7~
TO. AN A~D DA.~
SOMTHOLD~: N,:Y. 1'1'971
~5- x~o 02 - 304