HomeMy WebLinkAboutBoger, PeterELIZABETH A. NEVILLE, MMC
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
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: Carol Hydell, Southold Town Clerk's Office
DATED: March 30, 2015
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4298 for a Cesspool/Septic Tank Construction
Permit submitted by:
Samuels & Steelman for Peter Boger
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 application and location map of the project cited above and make the following
recommendations:
APPROVE V
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
Signature
Dated
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
X Residential @ $10 or ❑ Non -Residential @ $25
Application No. 9 g
Applicant Name: Samuels and Steelman Architects
Applicant Mailing Address;
Septic Tank Igor Cesspool IN
Permit No. R10-14-0049
25235 Main Road Cutchogue NY 11935
Brief description of Propsed Construction or Alteration:
New Construction of a new septic systems for a residence
Location of Proposed Construction/Alteration:
Owner of Property: Peter Boger
Owner Mailing Address: 244 Rockville Center Pkwy, Oceanside NY 11572
Property Address:
717 Private Road #12, Southold, NY 11971
Name and Telephone No. of Contact Person
Tax Map No.:
Nearest Cross Street:
Section: 87
Nassau Point Road
Tom Samuels, 631 734 6405
Block: 04
Lot: 04
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL.
Siganture of Applicant Date
Received by:
SUFFOLK COUNTY Sr
oz A
PERMIT FOlR A?PRC-VAL
SINGLUFAI 0"
DATE'-/
APPROVED
FOR MAYlIvIUM OF
EXPIRES THREE YEARS FROM DATE OF APPROVAL
pRoP05ED PUBLIC WATER SERVICE LINE
L I NE OF -15 FT SETBACK FROM
TIDAL YiETLANDS BOUN12RY
PROPOSED CONTOUR5.
EXISTING CONTOURS
RELOCATED r,>Rl\/EyiAy
EXISTING DRIVEWAY TO BE REMOVED
Abandonment of ex-
isting sanitary system must be in
-OmfOlmar,ce will, department requivet-nent Sub, -nit
-ompleted form W' VM- C) as proof LIMIT OF PROPOSED
LANDSCAPED BUFFER*
TEMPORARY STORM WATER RUNOFF CONTROL
MEASURE: PROPOSED HAY BALES 4 SILT FENCE
I-I�DURIN& CONSTRUCTION (SEE DETAIL)
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