HomeMy WebLinkAboutHermann, Betty M
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ELIZABETH A. NEVILLE, MMC c~'y Town Hall, 53095 Main Road
TOWN CLERK CD 7A P.O. Box 1179
rA Southold, New York 11971
Fax (631) 765-6145
REGISTRAR OF VITAL STATISTICS %rp #VW
MARRIAGE OFFICER Telephone (631) 765-1800
RECORDS MANAGEMENT OFFICER www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK ~p 2
TOWN OF SOUTHOLD D E C E ~ U E
20~ D
TO: Southold Town Building Department MAY 8
FROM: Carol Hydell, Southold Town Clerk's Office BLDG. DEPT.
TOWN OF SOUTHOLD
DATED: May 8, 2013
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4133 for a Cesspool/Septic Tank Construction
Permit submitted by:
Betty M Hermann/Robert C Leonard
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.
« , * # * ~ s s * * * s
I have reviewed the application and ation 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 7
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ELIZABETH A. NEVILLE Town Hall, 63095 Main Roa
TOWN CLERK p A P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O x Southold, New York 11971
MARRIAGE OFFICER
• ~ Fax (631) 786-6146
RECORDS MANAGEMENT OFFICER Telephone (631) 766-1800
FREEDOM OF 1
INFORMATION
OFFICER
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
r(!`~TNt~I-D~T
BUILDING Oc~ABTUIHOLD WASTEWATER DISTRICT
P.(-). BNY111971
Southold, APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 /or Non-Residential @ $25 _ Application No.~
Permit No.
Applicant Name M 1 ' I . ~Le r e\(\ C eo/ICAA
Applicant Mailing Address Gll 1
~Py Septic Tank~or Cesspool_
Brief Description of Proposed Construction or Alteration O e-L i
Location of Proposed Construction/Alteration:
Owner of Property: I 1 , Q ~r/1 fji /1/~
Owner Mailing Address:
~l-
1tq -71
Owner Property Address: S05 Nor-41A ~~1JV'2cJ 15~r-
,10 4 lq U9-7i
Name and phone number of contact person 8f I-eonq4 $/(y qEq,c)1(o8
Tax Map No: (NCO Section 18 Block '0 19 Lot ((p,
Cross Street (AOX A1k-
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVL WITH HEALTH DEPARTMENT APPROVAL
s $ ~
f Signature of pplicant Date
Received by:
N SURVEY OF PROPERTY
SUFFOLK C.ouNW DEPARTMENT OF HE LTM AT BA YVIEW
PERMRFORAPPR L
SI GLEFAMI FAMILY RES084CIEAND ESIDENCEMD
TOWN OF SOUTHOLD
r7"tMeH SUFFOLK COUNTY, MY
DATE ? H.S No. O ' 1000-78-08-18.1
SCALE.' 1= 40'
APPRDV OCTOBER 4 2012
JANUARY 17, 2013 (B.O.H.)
'~DTAL UM BEDROOMS MARCH 15, 2013 (REVISED S.T. LOCATION)
EXPIRES THREE YEARS FROM DATE APRIL 22, 2013 (od&UW
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aunty 48 yours TIC
~C84 '10 570U, inspectlonts)' SEPTIC 0C. so, educe
To ~
AREA= 35,728 SO FT eOrNEW 'EST HOLE DATA
0
¦ = MONUMENT BY MccDONALD G OSCEN SY! f' I f; C.MET?c
Elevations referenced to an assumed datum. 1/11 /t3 ' ~o ~P
/ am fa illar with the STANDARDS FOR APPROVAL
AHD CONSMU0770V OF SUBSWALE SEWAGE ~ - DARK RROM LOAN OL
DISPOSAL SYSTEMS FOR SINGLE FAANLY RESIDENCES - t'
and wN abide by the conditions met Korth there(n and on the
perm/t to construct.
The locotlon of waft. pub/k water and twrpods shown heron we )MM ANO. PALE RNOIW CLAYEY SAND SC ~ jq"p .
frwn AWd observations and or from data obtaA»d from others
ANY ALIERA7IOV OR ADD/TTON 7D THIS SURb£Y IS A NOLA7/ON _ ta• . YS. L/C. NO. 49618
OF SEC77ON 7209OF THE NEW.YOIRK STATF EDUCA7TON LAW. CONIC SUIT RS, P. C.
EXCEPT AS PER SECTION 7209-SUMWSION 2 ALL CER77F7CA770NS PAUi W0101 FNE SAND SP (631) 765-5020 FAX (631) 765-1797
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF p. 0. BOX 909
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR 1230 TRAWLER STREET
WHOSE SIGNATURE APPEARS HEREON. r SOUTHOLD, N. Y. 11971 F12-248