HomeMy WebLinkAboutTriantafillou, ChrisELIZABETH 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.nor th fork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO:
FROM:
DATED:
RE:
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
April 26, 2011
Cesspool Construction Application
(llOHlflOS JO NMOI~
Transmitted herewith is a copy of application No. 4010
Permit submitted by:
JNS Contracting for Chris Triantafillon
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 remm 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: j
APPROVE
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
Signature
Date:~///~
/-
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork, net
or Non-Residential ~ $25
Residential @ $10 ~(_ __
Application No.
Permit No.
Applicant Name
Applicant Mailing Address.
S~ticT~orCesspool ~;~ Q"~ N~.
BfiefDescfiphon of Proposeh Commotion or Alteration
~cation of Proposed Cons~ctio~Alteration:
O~er of Prope~: CJ~¢S Toia?l+q
Omer Mail~g Ad&ess:
Omer Prope~ Ad&ess: '~2.~ '~
Nme ~d phone n~.of con~ct person
T~ Map No:
Cross S~eet.
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SUR~~~L~ TH DEPARTMENT APPROVAL
Received by: ~/ Signature of Applicant Date
LOT A~EA = 17,§02 SQ. FT.
FFL ELEV=50.5
~'0~_~,..-'~ ~~ ~. ~ SUFFOLK C~OUNTY DEPARTMENT OF HEALTH SERVICES ~/~; ~,~
*ER
NOTE (~'~) ~13 2 96'
S~C S~M SH~L BE S 64'31'50'~
I-1~0 ~. S~C T~K LOT NUMBER 45
2-8' DIA. L~CHING POOLS 8' ~Ep
- PUBLIC WATER
DWELUNG
~ST HOLE by McDON~D GEOSCIENCE 8-31-10
O' -
~ ~WN LO~ OL
0.5' -
P~E ~OWN S~ ~D SM
3'
z, RECEIVED -
Locotion of woter moins
~ SIL~ ~D ~ 10-20~ & odjoiners woter supply
O~L ~ MAR 0 7 2011 ~ others ond ore not
32' - guoronteed.
NO WA~R E~OUN~R/D. SUFF. CO. H~LTH SER~CES
~GT.
5-3-2011 R~ISED PROP )~LLINO
~~~~~ JOB No. lO- 199
SU~ED FOR
~~~~~ LOT NUMAR ~2
~ OF ~RN SHORES AT OREENPORT
~~~~~~ TO~ OF SOUTHO~, SU~OLK COUNt, N.Y.
~m~~~~m S~ 1" = 40' DATE 8-~-2010
RLED MAP No. 4021 DATE 4-27-1964
CERTIFIED ONLY TO:
T~ M~ No. (REF ONL~ 1~-55-~-51 DISK 2010'
HAROLD F. TRANCHON JR. P.C.
¢ RD. WADING RNER,
--~ F~ . .Lic. No. 048gg2 NEW YORK, 1~g2
HAROLD F. TRANCHON JR. PENN. LIC. No. 21~-E 631--g2g--4695