HomeMy WebLinkAboutJuliano, JamesELIZABETH A. NEVILLE, MMC
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hail, 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 SOUTHOLD
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
January 24, 2013
JAN 2 5 2013
10Wrq OF S0tlTHOLD
Transmitted herewith is a copy of application No. 4194
Permit submitted by:
for a Cesspool/Septic Tank ALTERATION
Robert Tast for James & Lorrain Juliano
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.
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE ~
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings, property lines and water
Bodies. EXC~AVATION INSPECTION REQUIRED.
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTP~R OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
F~x (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.neL
RECEIVED
JAN 2 4 2012
Southold Town Clerk
Residential @ $10 t// or Non-Residential ~ $25 __
Applicant Name ¢0~
Applicant Mailing Address
Application No. L/[ qd
Permit No.
Septic Tank >( or Cesspool
Brief Description of Prpposed Construction or Alteration /.gal¢{'t/tJ~
Location of Proposed Constructio~
OwnerofProperty: x~ A-~4~*~.~ ~-~t2'Att~
Owner Property Address: ~2./_,~/~ 0~a-i'f'~ .~
Name and phone number of contact person .~lf~:, ~ t~ t4
Tax Map No: Section [O~ Block
Cross S eet gh0
NOTE: LOCATION MAP MIJST/~IE SUBMITTED WITIt APPLICATION, NEW
CONSTRUCTION REQUIRES SUR~/2EY ~rflTlCI ItE/<It DEPARTMENT APPROVAL
Signature of Applicant Date
Received by: ~
N
~ J) J Thom~, G. I*~lolperl;, F~ofe~lof~l ~m~imeer
5Ule. VIc-¥Of~.~ GIS~,TIFIC, ATION
L el
/ r'
5GALE~ = 50'
HEALTH G~EPAt~T1,4ENT
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
pERI, IT FOR APPROVAL OF CONSTRUCTION FOR A
Fo~ MAXI~U~ O~ ~ B~DROO~S
EXPIRES THR~E YEARS FROM DATE OF APPROVAL
AF~A · 2.~11E~54 A~I~5
FROM MI~ ~U~IVISION
,JAME JUilANO
LOT 2 MINOR ~UBI~IVI~ION - "INILLIAH HOLGHAN ~ VEF~.A I~OLGHAN"
~[ Mm~l[uck, To~n OF ~ou[hol~
~PFolk GounOd, Ne~ York
~l~l~ P~HIT ~ ]
~GOrd o~ ~VI6IonS
5Gclle, I" = I00'