HomeMy WebLinkAboutDougherty, WilliamELIZABETH 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.north fork.net
TO:
FROM:
DATED:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
April 10, 2012
BLOG. OEPl.
TOWN OF $OUTHOLO
RE:
Cesspool Construction Application
Transmitted herewith is a copy of application No.
Permit submitted by:
William Doul~hterty
4079 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 applica~on map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
ELIZABETH A. NEVILLE .-
TOWN CLEI1K
I{Ei~ISTRA~ OF VITAL STATISTICS
MAKPJAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFOI:LMATION OFFICER
.~Town Hall, §$095 Main ltoa,
P.O. Box 1179
Southold, NewYork 11971
Fax (681) 765-61415
Telsphone (681) 765-1800
sou tholdtown,northfork.ne/
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. ~ 0 7 ~
Permit No.
Applicant Name ~-/~
Applicant Mailing Address
Septic Tank ~'or Cesspool
Brief Description of Proposed Construction or Alteration
Reco~ved by:
Location of Proposed ConstructiordAlteration:
OwnerofProperty: ~ ,~ ,q~ qB ev,-~ ¼.~c
Owner Mailing Address: 3 ~ Z _C ~ or rl~ le B
OwnerPropertyAddress: t~81o 3oc~ vxdv ~.v~
Nameand phone number of contact person ,,~ m. Oo,xqhOc/-~ (~,,~) ~t *3'- ~ z 2~/
Tax Map No: t o ~o Section S' '~ Block 8 Lot G. 3
Cross Street ~.. ~,~ ~.~
NOTE: LOCATION MAP MUSrT BE
SUBMITTED WITH APPLICATION. NEW
Stgnatum of Applicant ~ Date
N
TF_,ST HoL,~ DATA
22'
WATE~ IN ~ROI~V CLAYEY SAND EC
WA ~'R IN BROIff( F1NE TO COARSE SAND
SW
N79-Z%'50"E
LOT 2
Devotions Refer to The Five Eastern Towns Topographic Maps.(NGVD)
Lot No.s refer to '*Minor Subdiv/sior~ for Doroski Family Limited Partnership"
Filed in The Suffolk County Clerks Office Feb.20,2007, File No. 11497
I am fam/Har with the STANDARDS FOR APPROVAL ~
AND CONSTRUCTION OF SUBSURFACE SEWAGE
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
and w#1 ab/de by the conditions set forth therein and on the
permit to construct.
The IocoUon of we/is and cesspools shown hereon ore
from field observations and or from data obtained from others.
ANY ALTERATION OR ADDllTON TO THIS SURVEY IS A V~OLADON
OF SECTION 7209 OF THE NEW YORK SLATE EDUCATION LAW.
EXCEPT AS PER SECllON 7209-SUBDIVISION 2. ALL CERTIFICATIONS
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR
W~HOSE SIGNATURE APPEARS HEREON.
NOTE: "LANDWARD EDGE OF FRESHW.ATER WETLANDS AS DELINEATED
BY CHARLES BOWMAN (LAND USE) NOV, 2OOJ k FEB~ 2004. ........ : : .
~, = WETLAND FLAGS
ST.
¢ 65~.~5'
R L~56,76'
rES THOLE (e/:2J')
~ (~OM FILED MAP)
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SURVEY OF PROPERTY
A T SOUTHOLD
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
1000-59-08-6. 3
SCALE: 1'--50'
FEBRUARY 6, 2012
FEB. 2z~, 2012 (revisionl
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICE
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
SINGLE FA['41LY RESIDENCE ONLY
HAR 2 6 2012
DATE H,:
APPROVED
FOR
EXPIRES 'I,' l..l F)
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1230 TRAVELER STREETI
~TH~D, N.~ 11971