HomeMy WebLinkAboutElliott, Robert go®st¢FOL4'
ELIZABETH A.NEVILLE,MMC se. ®®° ®�� Town Hall,53095 Main Road
TOWN CLERK `t x`= t P.O. Box 1179
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' Southold,New York 11971
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REGISTRAR OF VITAL STATISTICS �� � , �� Fax(631)765-6145
MARRIAGE OFFICER ' .�
. �' �'Aro. Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER �. ®�` � d� www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER - - ,.��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD i,A N 1 ' 2016L
TO: Southold Town Building Department _
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FROM: Carol Hydell, Southold Town Clerk's Office
DATED: January 12, 2016
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4356 for a Cesspool/Septic Tank Construction
Permit submitted,by:
Bay Creek Builders for Robert Elliott
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
Y'
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
riony‘e.e. e.(.9,74-
Signature
Dated
ELIZABETH A. NEVILLE ` G
' � _ Town Hall, 63096 Main Roa.
TOWN CLERK r P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER \r4fp $ON' lot Telephone(631)765-1800
FREEDOM OF INFORMATION OFFICER = '� * • 1. southoldtown.northfork.net
1 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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� SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential®$10 Yor Non-Residential @$25 Application No.' 356
Permit No.
• Applicant Name 17-5ava1,x--5 MCS",
Applicant Mailing Address (J- t (��3
Septic Tank. Cesspool . —
Brief Description of Proposed Construction or Alteration •TMJ lbtO a± $--�r n c..
�.� 44 `� (2t t e4 e(e) �+ r.
Location of Proposed Construction/Alteration:
C Owner of Property: 2.0 2T i ',A c -ry
Owner Mailing Address: 1 e 5"1"(L? '
C4 eea- Cly S tttt-2-0
Owner Property Address: 2S w � RAND
Name and phone number of contact'person 1w& i M G 6 3( ut c-'-t C 3
Tax Map No: . Section It 0 Block ai- Lot u-\
Cross Street Q k \ •
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY I' : 1 h ALTH DEPARTMENT APPROVAL
lop 4111 -
Signature of Applicant Date
Received by: `-�"
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SUFFOLK COUNTY DEPARTMENT OF HEALTI]SERVICES
PERMIT FOR APPROVAL OF CONSTRUCTION FORA '
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:. -to '4.'4.- No
DATE H.S. REF• NO, 1C,Q.71DQ
APPROVED -e./ �� — —
FOR MAXIMUM OF Li BEDROOMS
EXPIRES THREE YEARS FROM DATE OF APPROVAL
to) ' .V6� iifa
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3 REVISED 10/30/2015
2 REVISED 09/11/2015
1 PROGRESS PRINT 05/11/2015
number issued for date
PRINT RECORD
David Bruce Mann, Architect
122 East 55th Street New York,NY 10022
Tel(212)644-6416 Fax(212)644-6913
Client Date
05/11/2015
. ETI IOTT RESIDENCE Scale
275 WEST ROAD - AS NOTED
CUTCHOGUE NY 11935 -
Drawn By'
Title Sheet
RE.N I PROPOSED SITE PLAN S-1
QVV U 2 2015 Q-lo- t5"-oO59
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SUFF.CO,HEALTH SERVICES
OFFICE F WASTEWATER MGT.
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