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Home My WebLink AboutKeilELIZABETH A. NEVILLE, MMC TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER o�Da�,UFFOI,rcO OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Sabrina Born, Southold Town Clerk's Office DATED: March 9, 2015 RE: Cesspool Construction Application Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax(631)765-6145 W's;tholdtownny.go,� I '� 1 MAR 10 2015 i Transmitted herewith is a copy of application No. 4293 for a Cesspool/Septic Tank Construction Permit submitted by: Salvatore Morbillo Ens>aire Design for Keil 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. Sabrina M. Born I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: Final ant,roval required from the Suffolk County Health Department Signature Z/= Dated ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER �O�S�FFO(�-BOG co Z oy� � o�1-1r, OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax(631)765-6145 Telephone (631) 765-1800 southoldtown. northfork. net Residential @ $10 ✓ or Non -Residential @ $25 Application No. Li213 Permit No. ---� Applicant Name �igGyArU c ✓I�%1s/zC�i��v S'r� /��i= /d S"Z"t �. Applicant Mailing Address ENsa—mzcz:L2' s�� G��'✓/� �� Nom= L��'�� L L� Septic Tank or Cesspool Brief Description of Proposed Construction or Alteration Location of Proposed Construction/Alteration: �l G (V Owner of Property: A' E I G. TAU Owner Mailing Address: 44 7-3, Z '�" � T�/�/2 z �'`1 � Al"I 9� Owner Property Address: 73 5 eZ4X� l�ti�G �r � �� /� � i / 2— Name and phone number of contact person ��i /Ylv�'�?i«='/ 7i Tax Map No: Section l 3 Block /3 Lot Cross Street Gci / ��/�/�� iA �iJ U �" ��'� , �� z NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY ITH H ALTH EP TMENT APPROVAL ignature of Applicant Date i _ Received by: I �� SUFFOLEC COUNTY C PART.N4,211T OF HEALT H SEFZV ICES PER I f Fon . ^ �+_ :O I FOR A DA'ri:Z (3LI� a_. A10-1 `i -GJ�3 APPROV,',n Fop OiEs7RCt?;til-----..�... EXPIRES THREE YJARrI,FR0:,5 DA -1 E OF APPROVAL Abandonment of e;eistia sz;Iitcry s} item must be in COmfoTmance with der,: Mi ent requirement Submit �PSER completed fora V_AV-Na_ 0 2b as proof W' / EST HOP ��•5c x� ' LOCAtON 6 Nit -n X1 0 EXISTING FALLING 325 ' CESSPOOLT ABANDONED / f — EXISTING WELL CONNECTION TO `� $ BE DISCONNECTED AND CAPPED OFF ds (WATER USAGE SHALL BE FOR IRRIGATION ` PURPOSE ONLY) �5f-�"�"� Vk-TS A �Cg i RiS1Ofl u0?,fib. V� IR U P GAF, fRA PROPOSED3' WATER SERVICE 6. -n 6.5 —PROPOSE S- G c- 0 rnVIA