HomeMy WebLinkAboutWilson, MarylouELIZABETH 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 (63D 765-1800
southoldtown.north fork.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 8, 2012
Cesspool Construction Application
Transmitted herewith is a copy of application No. 4122
Pcrmit submitted by:
Jeffr¥ Sperling~ Sr. for Marylou Wilson
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 ltbrm 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
Signature
Dated --
I~L~ZABETH A. NEVILLE -~
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
REOORDS MA/~AGEMENT OFFICER
FREEDOM OF INFO1LMATION OFFICER
.~Town Hall, 53095 Main t~a*
P.O. Box 1179
Southold, Now York 11971
Fax (681) 765-6145
Telephone (681) 765-1800
sou theldtown.northfork.ne(
OFFICE OF THE TOWN CLERI~
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 or Non-Residentia! ~ $25 __
Application No. ~ ( ~
Permit No.
Applicant Mailing Address "~Q [S&~ ~
Septic Tank or Cesspool ~'~'
Brief Description of Proposed Construction or Alteration
Location o f Proposed Construction/Alteration:
Owner of Property: ~l/t ~
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person
Tax Map No: Section 10~ Block ~ Lot ,,~-~. f
CrossStreet &e>-~ c,~. ~[F
NOIE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITlt ~~PARTMENT APPROVAL
Received l~y: ~ *'
LOT 31
, /
LOT 2
SUFFOLK COUN'P~ DEPARTMENT OF HEALTH SERVICES
PERMIT FOR APPROVAL OF CONSTRUC330N FOR A/~
EXPIRE8 THREE YEARS FROM. DAz.~E OF APP
I --£XCAVATION INSPECTION REQUIRED]
FOR ~ANITARY I~Y~EM
BY ,HEALTH DEPA~ME~ ~ ~ 18 12 SCDHS R~SIONS
a
JR.
I 5 CASE COURT
SA",'~/ILLE, N.y. I I 782
531 5896171 fax 631 218.9~ 44
PROJECT
t
WILSON BARN / CABANA
1785 BREAKWATER ROAD, MA~CFITUCK, N.Y.
S.C.TM. 1000-106-8-20.5
DRAWING
DA~ PROJECT No
02-10-12 2011.30
DWG. NO