HomeMy WebLinkAboutRowe, Trevor
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ELIZABETH A. NEVILLE, MMC Gy Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
co Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS p • .!c Fax (631) 765-6145
MARRIAGE OFFICER Telephone (631) 765-1800
RECORDS MANAGEMENT OFFICER `ta www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK R TOWN OF SOUTHOLD
TO: Southold Town Building Department I
IAY _ 3 ~13 D
FROM: Carol Hydell, Southold Town Clerk's Office L G.DEK
TOWN OF SOUTHOLD
DATED: May 3, 2013
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4215 for a Cesspool/Septic Tank Construction
Permit submitted by:
Trevor Rowe & Lois Derosier
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 a s * s * s r * * * •
I have reviewed the application and location map of the project cited above and make the following
recommendations: /
APPROVE V/
DISAPPROVE
Comments: Final approval reouired from the Suffolk County Health Department
Signature
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Dated
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ELIZABETH A.
TOWN CLERK LE Town Hall, 69095 Main Roa.
y, - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER Fax (681) 766-6146
RECORDS MANAGEMENT OFFICER Telephone (691) 766-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD TOWN OF SOUTHOLD
BUILDING DEPARTMENT
P.O. Box 1179 THOLD WASTEWATER DISTRICT
Southold, N.Y. 11971
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 or Non-Residential @ $25 _ Application No.
Permit No.
Applicant Name /(2~!/d2q ~-'d
Applicant Mailing Address
Septic Tank or Cesspool .v
Brief D cript' of Proposed Cgn~t~ruucction or Alteration
S fi i4 ~t~f l r i~rl ~
Location of Proposed Construction/Alteration:
Owner of Property:..
Owner Mailing Address: Q 3
Owner Property Address: l/D F
Name and phone number of contact person 1141 ~ S'V9 /41 i x_636
Tax Map No: /BW"T"S"ect~ion _ Block_ Lot S
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY~KFIH EJWTH DEPARTMENT APPROVAL
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S' igature of Applicant D e
Received by:
GROUND ELEVATION 99.1' 'NOTE: SURVEY OF DESCRIBED PROPERTY
OL DARK BROWN LOAM PUMPED. COED AND SITUATED AT
- -0.5' h4jo I u W1Ta CLEAN SAND AND SO UTHOLD
GRAVEL AND TO BE INSPECTED BY
sc BROWN CLA'E' Sam S.C.D.B.S.
"NOTE. "NOTE. TOWN OF SOUTHOLD
-
-2" FO5ED CR DWWG SYSTEM SUFFOLK COUNTY, NEW YORK
1-1,,500 GAIT. ST.
1-8 DIA. 12 DEEP L.P.
SP PALE BROWN FBVE ROOM FOR 50% W. S.C.T.M. NO. 1000-61-4-15.1
SAND EL
AREA = EVATTON5~5AREe ASSUFT.
MED DATUM
NOTE: EXISTING HATER SERVICE LINE
FROM LOCATION BY CONTRACTOR AND
17' SHOULD BE LOCATED IN THE FIELD
TEST HOLE BEFORE SEPTIC IS INSTALLED TO
BY: MCDONALD GEOSCMVCE E~ MAINTAIN PROPER SEPARATION FROM
DATE: 1211712012 g~sL~pp ATER SUPPLY AND DWELLINGS.
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tiff -i tici PROFESSIONAL LAND SURWMR, P.C.
DWELLLN
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Water Line(s) MUST Be Inspected By The succESSOR TO -
!~.1 DMALO TASG LS
Suffolk Coun De t. Of He ~~11 D
tY P Health Services. NORRISTAR P.C
PAUL T. GANALQO, L~ A Iaar LS
Call 852-5700, 48 Hours In Advance, 6000 GROLAW SLWI YURS~ P.C.
328A Moire Street Nompton AMum Unit D-4
REVISED: °3/°7/2013 TO Sch .(~(lule InspeCticq(s). Center Moriches. NY +,9.T4 g ton Montwk Highno~•
REVISED: 02 07/2013 Hampton Boys, MY 11946
/ Phone: (631) 67a-0120 Phw% (631) 729-5330
UPDATE: 0110712013 ,//n Far. (631) 176-7190 Fax: (631) 729-6707
FILE NO. T33856 SCALE: 1 20' DATE: 07 21 1997 (9 Vcrl f 0 ~P~ et rd -j N.Y.S. LIC. NO. 049287
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