HomeMy WebLinkAboutMcCoyd, Sean
ELIZABETH A. NEVILLE, MMC h~0 Gy Town Hall, 53095 Main Road
TOWN CLERK P.O. Boa 1179
H Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS `gyp .te Fax (631) 765-6145
MARRIAGE OFFICER Telephone (631) 765-1500
RECORDS MANAGEMENT OFFICER www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK % `1 [s
TOWN OF SOUTHOLD
r ^ 15 2013
TO: Southold Town Building Department
L-
~a etPl.
FROM: Carol Hydell, Southold Town Clerk's Office orsr of SOUTALo
DATED: October 11, 2013
Transmitted herewith is a copy of application No. 4167 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Sean McCovd
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and 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
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells buildings property lines and water
Bodies EXCAVATION INSPECTION REQUIRED
Signature
2
Dated
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
DIResidential @ $10 or ? Non-Residential @ $25 Septic Tank la4 Cesspool B--~
Application No. Permit No. (o 7
Applicant Name: ) t CCn Y cQ
Applicant Mailing Address: 93(10p h Z1%%AQ Q t.,. 9(a
Brief description of Propsed Construction or Alteration: Gre L-- up scc e cG fFxL t F
~Locah~ on of Pro sed nshuctton/ c :tUo~P~`c t 1- wGs ~t.~ ~y P, e'f
Owner of Property: SZ7 N P Zs
Owner Mailing Address: 33(. K , Q ( v
At-o(ek N`k ll~l~ l
Property Address: 33ta--)~ }1, (?d
G&-4c%4 LA ply t
Name and Telephone No. of Contact Person: 6e4, Nl (!(g4,Z <s'j Q C q b g 6(m
Tax Map No.: Secttron:' ^ 9 -7 Block: ~ 3 r Lot:
Nearest Cross Street:
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL.
( /o 6 t3
Siganture of Applicant Date
Received by:
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Qom` 44,v- . ~ SURVEY OF PROPERTY
AT LAUGHING WATERS
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NY
N89046'070E 1000-67-03-66.4
46.39' CO* SCALA* 1=30'
4- S6s30, ? DECEMBER 19, 2012
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(Oam familiar with the STANDARDS FOR APPRt
-Cz Q AND CONSTRUCTION OF' SUBSURFACE SEWAGE
v' a a? DISPOSAL SYSTEMS FOR SINGLE F"AMII. Y RCSII7t
nr~ and will abide by the conditions set forth thel
e40 Permit to construct.
w~~QJ fie location of
oo/s & Public water
from Field o ~a r from data obtc
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• ELEVATIONS REFERENCED TO N.A.V.D.
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SURVEY OF PROPERTY
AT LAUGHING WATERS
TOWN OF SOUTHOLD
SUFFOLK COUNTY, MY
N89.46'07"E 1000-87-03-66.4
39' Cb . SCALE. 1-30'
UNE 4 Sss~ DECEMBER 19, 2012
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l am famli.ar with the
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xr DISPOSAL SYSTE'M'S: ,
and will abldl ay +rr
permit to eon~b~> rho locotlon,
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