HomeMy WebLinkAboutDiller, John CELIZABETH A. NEVILLE, MMC
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, NewYork 11971
Fax (631) 765-6145
Telephone (631) 765-1800
www. southoldtownny, gov
TO:
FROM:
DATED:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTttOLD
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
December 21, 2012
RE:
Cesspool Construction Application
Transmitted herewith is a copy of application No.
Permit submitted by:
John C. Diller
4129 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:
APPROVE J
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
Signature
D at ed/~/"~/2'''
SURVEY OF PROPERTY
SITUATED AT
LAUREL
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-145-02-1.2
SCALE 1"=40'
NOVEMBER 2, 2005
AREA = 21.275.42 sq, ff.
"athan"<~a~-~rwin ill
Land Surveyor
Ol~l~ O~' 'l;u~ 1"OWN ~
TOWN OF 80,~I'EOLD
P.O. BOX irTo
SOUTHOLD, N~W YORI~ i 1971
Telephone
(63i) 765-1800
Application
Construction
Altera[ion
$10.00 -Residential ~
$25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DIspoSAL DISTRICT
A__PPLICATION
for
CONSTRUCTION -~ ~=L=,I~E=I~A~ p E RM i T
SEPTIC TANK or CESSPOOL
Permit No...~(~
Fee '$ IO oo
SEPTIC v~CESSPOOL V
DESCRIPT?pN OF: PROPOSED CONSTRUCTION OR
aero re~(~h~ 5~s~a,L~ ^'-TERAT,ON
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION QR AI.TERATION:'
OWNER OF PROPERTY: ~2'~t~l ~'~Oi llmr'
TAX MAP NO.: Section,,,,,
cROSS S~a~T:
BUILDING PERMIT NUMBER CROSS REFERENCE:
RECEIVED BY: (~ Li/~._ ?~. ~/ Signature of/~3plican{ - Tmdn Clerk's Office