HomeMy WebLinkAboutPisani, EdwinELIZABETH 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:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
September 23,2011
Transmitted herewith is a copy of application No. 4044 for a Cesspool/Septic Tank Construction
Permit submitted by:
Mark Scwartz for Edwin & Margy Pisani
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and retum it to me.
I have reviewed the application and location map of the project cited above and make the following
recommendations: ~
APPROVE
DISAPPROVE
Comments:
ELIZABETH A. NEVILLE
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.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
.APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
/
qoq
Residential ~ $10 x/or Non-Residential ~ $25 __ Application No.
Permit No.
Applicant Name
Applicant Mailing Ad'ess vft~ ~tg)~f V~.~3 ·
Septic Tank b/or Cesspool ~/
Brief Description of Proposed Construction or Alteration
AJ~ g~777c f q
Lz~tion of Proposed Construction/Alteration:
Owner Property Ad~X~ess: ~ / lq5 fCo[o~b~,~¼~ann4
Nme~dphoaen~berof~nmctperson ~ 3~~F[
T~ Map No: S~tion / ~ ~ Block It ~t Y, /
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITCH APPLICATION. NEW
~/~r Si~ature °f Applrc~7~ Date
Received by:r ' g
EL. EL.
EL. 10.0'
6.4' 16.3'
GREAT
PECONIC
BAY
N 21° 15' 40" 'gU
RIGHT OF
EL EL. S 20° 44' 00" E
6.0' EL. 17.2'
10.0'
N/O/F
JOAN SHANNON
D~ELLING
[PUBLIC WATER]
EL
20.1' ,,.gl/-
EL
RIGHT OF WAY ~
N/O/F
SITE PLAN Jo...,.sc.
DWELLING
SCALE: 1II = 301-01 [PUBL!C~;(/ATER]
.
4 / / ~ ~ONE ~ Xq ME~S AND BOUNDS BY: NA~}A~ COR~N
LICENSE No.
PROPEE~ ~URV~ED: ~ECH 01.~011
S.C~,m~~~~, 1000-.___~]_26-'11-9.1
_ _ EPARTMENT OF HEALTH ~ J
PERMIT FO~ J~aPROVAL OF CONS'TRUCI'ION ~ A J
SINGLE FAMILY I~E$IDENCE AND J
EXPIRES THREE YEARS FROM OPTE OF AP?F~OVA~