HomeMy WebLinkAboutO'Keefe, Paul & TessELIZABETH 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: Carol Hydell, Southold Town Clerk's Office
DATED: May 21, 2015
RE: Cesspool Construction Application
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MAY 2 2 2015
RN,- DLP(.
Transmitted herewith is a copy of application No. 4318 for a Cesspool/Septic Tank Construction
--__----------__,_..-------..-------�__--------------__.-----
Mark Schwartz for Paul & Tes O'keefe
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
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
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Dated
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Residential @ $107
Applicant Name
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
or Non -Residential @ $25
e -S
Applicant Mailing Address fa 15� e G%J3
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown. northfork. net
Application No.
Permit No.
7—
Septic Tank V or Cesspool_ 1 A�
Brief Description of Proposed Construction or Alteration \
Location of Proposed Construction/Alteration:
caner of Property:Z II/0%z��lV 0%Z -
Owner Mailing Address:
7 Peee�r,e���
Owner Property Address:w�✓�W1�f�1G}2 ; N �
Name and phone number of contact person���C ck,
Tax Map No: Section l 5 Block dj Lot _
Cross Street 7-8 f2 A5-' wA-7r_,R f L A70L
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY H DEPAR NT APPROVAL
Signature of
Received by:
Date
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AREA: 21 607.50 SQ. FT. or 0.50 ACRES II, IV C °: Itf I l i z Iu . Y,r 'r i� , � a,1 a ab ' ;� Q a ( r I
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UNAUTHORIZED ALTERATION OR ADDITION TO TH/S SURVEY IS A VlOLIIT%ONF^SEL`StOIV`720901 'i �l sW'" %`{I�s'rs +tiy1"'°ri' ''` I' `""' `t i �I
- rl ,, z.1 Zl. 1r'` , rM�IN6 j -fd) K,�TATf EDl1CA1tONi LAW' ,COPIES#OFT7HiS SURV IfY
MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL Nr �',BE,,GONS/DERE'D pT0$_ 86�, i. MA• LID TRUE CO,PY , ,GUARAN ��S, (NpIC ,TEAT HEREO"' HALL R(/N
ONLY TO THE PERSON f"OR WHOM THE SURVEY /S PREPARED AND ONNW511 r, Q TO�'ITHE'`,iT TLEI 'CO PANY' GOVEANME' ;T 4L'`A'GENCY Al1f LI N!DING siMS; ITI/T!0 E I' v
LiSTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUAQN 'GUARAN�EE�S REO,"T +1RA11%FERABLE r} ` I i I i'` 4 �'} y } I
THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TD;;THEfSTRUCFURES ARE FOR, A' SPECIFIC PURPOSE 9ND USE THEREFOR.THE�'°AR£ '
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THS ERECTlONibF: FENCfS,{'ADDI.'F/ONAL, STRUCTU$ES,'OR, ANb ,O�IIER,�MP�7OVE`ME�1%TS . iEASEMENTS;
AND/OR SUBSURFACE STRUCTURES RECORDED'OR UN D ARE•'NOT CUA4RANT�E'D UNLESS PHYS%CALLY EVIDENT ONrTHE IPREMi$ES A' ITKE TIME �Fi'S�IRUEY :. ; � 1
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