HomeMy WebLinkAboutFitzpatrick, StephenELIZABETH 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.nor thfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
FROM:
DATED:
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
August 15, 2012
AUG 1 5 2012
RE:
Cesspool Construction Application
Transmitted herewith is a copy of application No. 4102 for a Cesspool/Septic Tank Construction
Permit submitted by:
Tom Samuels for Stephen & Renee Fitzpatrick
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.
1 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
Signature
Dated //~//)~/L-
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTP~,-R 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. ~-~ ~ 0 '~
Permit No.
Applicant Name ~-~//ffqY~~' '-(~ff]~]{~ e ~}~,/~ /~7~-~/(:¢T7~'
Applicant Mailing Address ~-~,~-z03~- .Z~,,~Z/t/ &5~?/q-_~/ ~.7-c_2
Septic Tank ,'/or Cesspool__
Brief Description of Propose~l Construction or Alteration
Location of Proposed Constmction/Alteration:
fi/o/
Name and phone number of contact person ~-~f
Tax Map No:/C:OO Section ~ B}ock Off-
Cross Street 6~00 -F&~-
Lot ¢0, [
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Received by: ~
Signature of Applicant
Date
SEPTIC PROFILE
(N.T.S.)
SCTM # 1000-35-05-40,1
PROPERTY: 415 WIGGINS LANE
ADDRESS GREENPORT, NY 11944
OWNER: STEPHEN J. FIT'~ATRICK
2-01 S0th AVE., APT. 17H
LONG ISLAND CITY, NY 11101
SITE: 67.082 sf = 1.540 ac
SURVEYOR: John Me~ger
Pecomlc Surveyors, PC
PO Box 909, Southold, NY
LICENSE # 49618
DATED
LOCATION MAP
~ LINE FI P'M'A'T'I<::~ q.I P"T. ,'~- SUFFOLK COUNTY DEPARTMENT 'OF
HEALTH~ERVICE8
PERMIT FOR APPROVAL OF CONSTRUCTION
FOR
A
~*j..~GLE FAMILY RrSlDENCE ONLY
I E .~,.~'J I I ~. +~a~' J I [ ............. / ~ DATE ~S.
- ~ ~ATION ~(~ ~ PlAx4
~ ~ ,,, ~oo~
I ~ ~ X' ~ ~ ~ TEST HOLE
~ / NO SCALE N~ YORK 11971
~ ~ ' ~ ~ . TEST HOLE DATA (~5112) ELEV. 9.0
I X ~ ~.,,. /,._,,
O ~ ~ __ WATER IN PALE BROWN
~/ ,, ~'~. ~ ~ co..~.,~ w~. ~.~.~.~.~.
t ~ ~ ~5~ TO ~ ~ ~ ~ ~, _ BELOW SURFACE, E~.9'
~ J~ ~ TO ~AIN
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