HomeMy WebLinkAboutSmith, Peter
~ggfFOC,~cO
Q Town Hall, 53095 Main Road
ELIZABETH A- NEVILLE, MMC =QJ2 P.O. Box 1179
TOWN CLERK y Z Southold, New York 11971
a T Fax(631)765-6145
REGISTRAR OF VITAL STATISTICS Oy
MARRIAGE OFFICER Telephone (631) 765-1800
.S
southoldtown.northfork.net
RECORDS OF MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Carol Hydell, Southold Town Clerk's Office
DATED: September 27, 2012
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4III for a Cesspool/Septic Tank Construction
Permit submitted by:
Am Martin of Fairweather & Brown
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
I have reviewed the a lication and location map of the project cited above and make the following
recomme o 'f el
I
APPROVE
Comments: Final a royal required from the Suffolk Count Health Department
Signature
Dated
G `~LO~Z
~gUFFO(,~C
ELIZABETH A. NEVILLE •tQ
TOWN CLERK b Town Hall, 68096 Main Roa
P.O. Box 1178
REGISTRAR OF VITAL STATISTICS y, Southold, New York 11971
MARRIAGE OFFICER Q Fax (681) 766-6146
RECORDS MANAGEMENT OFFICER Telephone (681) 766-1800
FREEDOM OF INFORMATION OFFICER 1 J(
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/ V or Non-Residential @ $25 _ Application No.
Permit No.
Applicant Name 74M /Y)AI ~/<J ~rBcE7 i7
Applicant Mailing Address 2.O S Pro-e., .
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration Yl&L4 0-r ,Fey- s fl.0414--c-
Location of Proposed Construction/Alteration:
Owner of Property:_ I~.Qip~ yy-, y
'h
Owner Mailing Address: L.A. ~iIZ (Z
't~D-v zOl
Owner Property Address: 1300. Fbw Dg i
i PnI
Name and phone number of contact person Amy cvy'~,n cf 1
Tax Map No: Section 1_ Block 3 Lot _q•
Cross Streetfi as
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES S7SignY ;0fcant E EPARTMENT APPROVAL
D e
Received 6y:
t EACAVAATI N T RC ION REQUIRE
BY HEALTH DEPARTME?TT
01 \
/ ,X
,oo mU<
~~oo ~a.oo
- i ~Mro«
Afk
,1c ~ ~ - ~q \ ae,e.~
/ V PROPOSED SEPTIC SYSTEM DETAIL
I \ \ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICE
/ \ \ PERMIT FOR APPROVALOF CONSTRUC'T10N FOR A
Gut
~ rSo
s • \ H.S. O•
i _ I \ OATS Ct»
I~~DI
I
. APPR
, ,y . TOTAL UM BEDROOMS
a(pIRES THREE YEARS FROM DATE
bA-1-q ON
PE- !FOB- / pb/btls!S
-
~UF rOlc.. oL~N-~r.v.r.+,;' albrWap' d
O \ NO, 1000 115 y ~ a \ TIM
~p/ed in on wMti o no
/~T > V7 I I '
AREA 2,9182 ACKf',
ET IS A VIOLATION OF THE AED AqC
LAW FOR ANY PERSON, ~y~~ T 1. Bq tiiT~
\ / t4 ErJi UNLESS ACTING UNDER THE Oiy n
z / DIRECTION OF A LICENSED p 2
ARCHITECT, TO ALTER ANY
!TEM ON THIS DRAWING IN
\ \ _ - _ /v G V~ / N ANYWAY
ANYA'..THORIZED
f \ \ / ` Q ALTERATION MUST BE
NOTED, SEALED, AND p
DESCRIBED IN ACCORDANCE r9 , y P
i E ROBEI~~`'I Uaw
SMITH O'NF OWN ARCHITE
\ \
/ REV. 06113/(- s
DESIGN A550CIATE5, INC.
RECEIVED
/
0717/70 2 2051 BA AVL` v!UE
' i
\ \ ~CA,! 50' AUG 16 23;2 c `=LNP0 N ,Y,
/ SUFF. CO. HEALTH StRACES + a J2 ( 3'' °