HomeMy WebLinkAboutAndreadis, Katheriner
ELIZABETH A. NEVILLE, MMC
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
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Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
www.southoldtownny.gov
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 18, 2014
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4222 for a Cesspool/Septic Tank Construction
Permit submitted by:
Mark Schwartz for Katherine Andreadis 36-2-10
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 have reviewed the applicatioAand cation map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
Signature
Dated
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown. northfork. n et
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 ✓ or Non -Residential @ $25 Application No.
Applicant Name
Applicant Mailing Address_ toe &ay=
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property:
Permit No.
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Owner Mailing Address: l S- O %n ec- 4./!r_
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Owner Property Address:
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Name and phone number of contact person/ /��4'17}/�✓� •4 , 2.17 -
Tax
7 -Tax Map No: Section 3 (D Block r% Z Lot ( G
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
od
Signature of Applicant Date
Received by:
SUFFOLK CONW DEP AR OF HEALTH BERVICES SCDHS Ref. # RIO -98-0082 7 .
PERMIT FOR APPROVAL 0 CONSTRUCTI*N FOR A
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APPROVED
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EXPIRi-3 THREE YEARS'FROM DATEOlr APPROV 014/
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PROPOSED sEPric SYSTEM t °
c t4 BEDROOMS MAX.1 LOT COVERAGE OL
HOUSE 870 sq.1t. o
I - 1.000 sat_. PRECAST SEPTIC TANK SHED 98 so.lf.