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Home My WebLink AboutSmith sout ELIZABETH A.NEVILLE ® Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS 42CSouthold, New York 11971 MARRIAGE OFFICER • �� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICERl Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER ycoUff1,+1y southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3569 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : JUSTIN J. SMITH Address 1: 1040 FOUNDERS PATH City St Zip SOUTHOLD NY 11971 Descripton of Proposed Construction or Alteration -ADDING OVERFLOW CESSPOOL NEXT TO EXISTING ONE. -MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner SAME AS ABOVE ------------------------------ Mailing Address 1 ------------------------------ ------------------------------ City St Zip 0000 -------------------- -- ---------- Property Address 1 SAME AS ABOVE ------------------------------ ------------------------------ City St Zip 0000 -------------------- -- ---------- Tax Map No. section 64.00 block 2 lot 1.500 ------ --- ------ Cross Street LANDON LANE ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 7/19/07 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) � SOUry®l ELIZABETH A. NEVILLE O Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER ® �Q Fax(631) 765-6145 RECORDS MANAGEMENT'OFFICER lyC Telephone (631) 765-1800 REEDO IF D M' TON OFFICER oU e �-- t �� , southoldtown.northfork.net t JUL 7 a OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD - o �'— - TO: Southold Town Building Department FROM: Lynda M. Bohn, Southold Town Clerk's Office DATED: July 17, 2007 Transmitted herewith is a copy of application No. 3728 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Justin Smith Please review the application and location map and advise if the project has received Suffolk County Health Department approval and if this office may issue the permit. Please complete the form below and return it to me. Lynda M Bohn I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: Maintain required setbacks from adjacent wells, buildings,property lines and water Bodies. EXCAVATION INSPECTION REQUIRED. ti Signatu;Ild 0,7 Dated L � CCC ELIZABETH A.NEVILLE �`1° Gy Town Hall, 53095 Main Road TOWN CLERK o P.O. Box 1179 CIO Z Southold, New York 11971 REGISTRAR,OF VITAL STATISTICS MARRIAGE OFFICER Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER fol ��® Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 or Non-Residential @ $25 Application Permit No. a Applicant Name ,IS ( � J . 'i-4 Applicant Mailing Address / (J V6 FQ q !I Ax S 402 t H SO (4f/\Ql 7 Septic Tank or Cesspool Brief Description of Proposed Construction or Alteration Location of Proposed Construction/Alteration: Owner of Property: J& 57:61 J- Owner Mailing Address: Owner Property Address: Name and phone number of contact person Tax Map No: Section (2 1/ Block 2 Lot �30? 1^7W Cross Street 4 k1 0 k7 42 NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVE WITH HEALTH DEPARTMENT APPROVAL Signature of Applicant Date Received by: NOU b'70,Mb' S/ `4 3j�6/7S S/Hl Ol NO/1/OOd &0 0 do NOLL�3L .( v v _ 1 N3` l?Non=■ �OQ. dd of M9 � 1N3W3►` M+0 Mt3� 1 Y3 too Nv \'p OZ yo'1 M 96 T \ J VA y OZ d � \ 0� Z� y �••dam � 6� y4� o '' /✓ o y / x s,£o W ; \ Id 5'6.1 W► �un 0�: y0� OIL TA uno