HomeMy WebLinkAboutPhillips, MichaelELIZABETH A. NEVILLE, 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:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
November 2, 2011
Cesspool Construction Application
Transmitted herewith is a copy of application No. 4058
Permit submitted by:
JNS Contracting for Michael Phillips
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: j
APPROVE
DISAPPROVE
Comments: Final approval required fi.om the Suffolk Count3' Health Department
Signature
Dated 1--
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, 63095 Main Pos,
P.O. Box 1179
Sou~hold, New York 11971
Fax (631) 765-6145
Telephone (681) 765-1800
southoldtown.nor~lffork.ne(
Residential ~ $10~/ _ or Non-Residential ~ $25 __
Applicant Name
Applicant Mailing Address
Septic Tank ~ or Cesspool
Brief Description 9.f Prqposed Construction or Alteration
Application No. ~
Permit No.
Locati°n ° f Pr°p°sed C°nstructi°n/Alt~rali°n: Owner of Property:
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person
Tax Map No: Section '~ ~
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEy ~TH HEALTH DEPARTMENT AtPPROVAL
. It/2/
Stgnature of Applicant Date
R~eoived I~y:
Abandonmenl ofcxistln,~ sanita~t system must b~ in
~lo,se.~ sq.n=o.~aos ~c~s ~vatio~ 1~ eotlo~ ?' ~;* st' PERMIT F~APPEOVAL OFCON57RUCTION FORA
2,259.82 Sq. Ft. = HOUSE ~$ ~ ~ : or ~x sr;*. ~m~ '~,~ .
~.0,2.~/S9.rt.= NOVS~ ' _ ~ ~~s},, x,,2~' ; ~ I mPiRESTHREEYE:,RSFROMDATEOFAPPROVAL
J, tgt. t7 Sq. Ft. = 13.839~ LO~ COVZ~GE ..... w~-- -~ ~
(IO'O"$~ETg~ Z 6'6" PEEP POOL).
· EXFAVATE DO~ TO ELE~A~ON -6.0 ~D REP~CE ~ITH~ ~~
· EXCAVATION INSPECT~N MUST BE PONE ON-SI~ BY ~~ ~_ _ ~
LE~ERS ~ CUTTgRS TO DRY'WEL~
(OESICNEO FOR ~" ~IN F~L) STAKE NOTES:x~~'~"~ ~
HOUSE: 2,575.17 Sq.F~ X 0.1~6.? X (I) = 429.28 C~Ft *ON ~H l, 2011 SET (3) ST~KgS ~ONG THE ~ OF THE
429.28 C~t. ~ 42.~ = 10.16 ~ ~O. ' no~ . ~ ~*' HOU~ MNg EX~KD~D ~D ~) ~E AT TEE ~OL CO~BRS.
vsr ~ t) s'o'v~r~a x t t'o'otrv ~m~c oarwr~- ~ -,. ....~ -. . .. (zxt~t~c ~vsz zNcuusr~. ~ our or zxl~ COnNrRS LEACHINg BAS~