HomeMy WebLinkAboutVerity, Michael (2)ELIZABETH A. N-EVII.LE, MMC
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS OF MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, NewYork 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
TO:
FROM:
DATED:
RE:
July 25, 2011
Cesspool Conslruction Application
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building Department ~t ~
Carol Hydell, Southold Town Clerk's Office
TO~iN OF
Transmitted herewith is a copy of application No.
Permit submitted by:
Michael Veri ,ty
4028 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.
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
~ignature
Da(ed
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTI:t. AR 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. ldo
~- ~ Permit No.
Applicant Mailing Address /~,O, ~/--~?~ ~ "77~r~, ..//
Septic Tank ~ ~i[CCesspool ~'~ r),~,~ ...... ~._
Brie~Descri-pt~o~ of Proposed. ~oomg'ucfio.n. or _A~teratigj~ ' c~.,--~.z, af-,~
Location of Proposed Constmction/Al[erat~io,n: /
Own roeerop y:
Owner Mailing Address: ~.O. ~ ~'?~
~ 97. y.
Owner P 'ope Address: 7
Name and phone number of contact person
Tax Map No: Section 3 ~---- Block / Lot
Cro~s Street C,~ ~'
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH, HEALTH,DEPARTMENT APPROVAL
.~p f, n Signatureof)kpXicant ~/ Date
_
;'FOLK COUNTY DEPARTMENT OF HEALTH SERVICES
'ERMIT FOR APPROVAL OF CONffI~RULTION FOR A
~. (~-'-/,,- I o Hs~.)~O. ~q b-Oc~
TEST HOLE DATA
FILED MAP
0.0
TOP SOIL
SAND &
16,0
DATE: MAR. 17, 2010
JOB NO: 2010-058
CERllFIED TO:
MICHAEL d. VER TY .
DA~ID H. FOX, LS. P.C. N,Y.S. LS. ~50234
FOX I,/L, YD SURV, EYTNG
64 SUNSET AVENUE
WESTHAMPTON BEACH, N.Y. 11978
(631) 288-0022
DWi: 2010-058
Survey for:
MICHAEL J. VERITY
Lot 5, "Michael Verity"
At
Greenport
Town of
So.tho ld
Suffolk County, New York
S.C.T.M.: 1000-035.00-01.00-004.007 & 004.002
SCALE: 1"= 50'
NOTES:
1. AREA = 146,285 S.F.
2, ·= MONUMENT FOUND. A _- STAKE FOUND.
3. SUBDIVISION MAP 'MICHAEL VERITY' FILED
IN THE OFFICE OF THE CLERK OF SUFFOLK
COUNTY ON JULY 26. 2007 AS FILE NO.
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