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HomeMy WebLinkAboutChristiano, Cheryl SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3956 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : COASTLINE CESSPOOL & DRAIN SRV Address 1: 4225 BRIDGE LANE City St Zip CUT CHOGUE NY 11935 Descripton of Proposed Construction or Alteration ADDITION TO EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner CHERYL CHRISTIANO ------------------------------ Mailing Address 1 1140 DEEPHOLE DRIVE ------------------------------ ------------------------------ City St Zip MATTITUCK NY 11952 -------------------- -- ---------- Property Address 1 1140 DEEPHOLE DRIVE ------------------------------ ------------------------------ City St Zip MATTITUCK NY 11952 -------------------- -- ---------- Tax Map No. section 115.00 block 12 lot 16.000 ------ --- ------ Cross Street RICHARD STREET ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 5/26/10 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) SO!/r'yo ELIZABETH A. NEVILLE,RMC,CMC '�� l0 Town Hall, 53095 Main Road TOWN CLERK l�i [ P.O. Box 1179 REGISTRAR OF VITAL STATISTICS N Southold, New York 11971 MARRIAGE OFFICER �O Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER 2 Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �UNT`I,� southoldtown.northfork.net OFFICE OF THE TOWN CLER E C E D U E TOWN OF SOUTHOLD D MAY 242010 TO: Southold Town Building Department BLDG.DEPT. TOWN Of SOUTHOLD FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: May 24, 2010 Transmitted herewith is a copy of application No. 956 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Coastline Cesspool & Drain Service for Cheryl Christiano 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. * * * * * * * * * * * * 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. s" Signature `14e Ig Dated ELIZABETH A. NEVILLE �`1`� �Gy Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 : REGISTRAR OF VITAL STATISTICS v. � Southold, New York 11971 MARRIAGE OFFICER Oy �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER O'� �a southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK 3 Residential @ $10 r or Non-Residential @$25 Application No.<� Permit No. Applicant Name�„�� a'e'-sC�E Applicant Mailing Address Septic Tank s-- or Cesspool Brief Description of Proposed Construction or Alteration G� Location of Proposed Construction/Alteration: Owner of Property: ��4x,✓� �'Itfr.�.✓o Owner Mailing Address: ,/.r= /��_ Owner Property Address:_ Name and phone number of contact person' /r//,�,�,� Tax Map No/�D Section //S Block /j Lot /6 Cross Street��r _S NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH PARTMENT APPROVAL Signature of Applicant Date Received by: w atw �.!•M aiK �a pfi� cg `acv ,rte � 3 " Vii• e a l '! e " 'U V m ki I � aea 4L F 51 ' " Q} rJ— IT E [ R7 A AAe.�aa yc ya 1 sa'a"a�a4� td ,Su�-`ac.•e coo-u+rrt' ?�"� M.SFP L4 @.rOcc .xe'r,rJs ALA-- r8 mT/6 fAEASUtiMUT IN ML STAHOARU _ jLmjjts,jqEr, & PJ•sL1t• 1-Wom mme SNOW"WERMN,"mTmasm nvfm TO T"e PROPENiY L'mAPEFOR ABPEgRCPUAP(M ONLY,THEY ME. SECTION BLOC[ DATE LAW WRYEY�g�p NOT RMWM TO REWW FOR WE WAC OF VINCEZ,IMMURES OR A"OMNI GORQPCs6EAC: Swf^rows 7 noMoTEACLOFA16nTOFWAYAMUM MEi1 N OF IRECONA W ANY-NOV#WONAn AWQUAUN� GUARANTEED TO .atfri�y� t,..Pw.rc.P�rR•st^e�suag��aee aa[,�sss.-nw+• - J WABANfm AWSA Warm SW.LL ROA OWT t_.-- ONAffTHOR1IE9 A1TEiSATIOH OHLY COMER FAQF[11�aftF"i RD✓•s�Ixa es TYRE ,c,sc-.r+c�w.ct �,vFf'eLC TO TSE PC-AaON PON AA RIE SYAVkY IS FAB^ 1,Ispt3,;]s! 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Open Grid Decldng T9 Drive -1 rin Smanarflarnp 118'&Floo C x 20' L; to i r." f Lu 00 `' Ghrrstranson U5 01 Uj > 0 0 LL. ad a 0 Proper ac z 1 4 Ir Section Dock Vxlg CL I'= 10' proposed ruin.25 abv. gr. coca SeasorW Lawn Proposed Ramp 3'x Is' Open Gdd DeKMNng Seasonal Float G'x 201 ttand HN 405.0tv.=ad SEA ; R. Fox LEVEL Dec. '06 MAPPING 6"dlaL 631.7n4=00 Plies P08u#L% i W F14 F7j —r--.— -J�4a. w O.C. F#V8IWW 6XI-5t.i2ttm- Al I Construction Flomw H.Fax Ox So k tj�; (2)fr dia. (4 tail) WSPLS#60107 MaterlcA5 frorn anchor pbs roved List ----------_ ...__. - _ -= ------ SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4418-R Residential X Non-Residential Fee $ 10.00 New Existing X I Name Of Owner CHERYL CHRISTIANO \AY-44� ------------------------------ �, Q Mailing Address 1 1140 DEEPHOLE DRIVE ------------------------------ Mailing Address 2 City St Zip MATTITUCK NY 11952-0000 -------------------- -- ---------- Property Address 1 1140 DEEPHOLD DRIVE ------------------------------ Property Address 2 ------------------------------ City St Zip MATI'ITUCK NY 11952-0000 -------------------- -- ---------- Owner Telephone No. 000-000-0000 ------------ Tax Map No. section 115.00 block 12 lot 16.000 ------ --- ------ Cross Street RICHARD STREET ------------------------------ ---------------------------------- Issue Date: 8/02/10Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) ELIZABETH A.NEVILLE �� y< Town Hall, 53095 Main Road Cz TOWN CLERK W P.O. Box 1179 REGISTRAR,OF VITAL STATISTICSO � Southold, New York 11971 NS RFax (631) 5 MANAGEMENT OFFICER �� �aO�� Telephone (63 6 -6145 RECORD765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 or Non-Residential @ $25 Application No.�J U Permit No. g 5lO ►� Owner Name C-A e iii L CLir�s �i o Owner Mailing Address 11410 e e p I-lo L e P.- ve &1-rT-1 �vc 2- Owner Owner Property Address Owner Telephone No. �lO 31 Tax Map No: Section /IS, 00 Block /a Lot 16 , O o 6 Cross Street 2 c a.,cy/ e � Please check each that applies: New Construction Alteration to Existir g System Residential ✓ Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SCHD approval.) tore of Applicant Date Received by: %---=---•• ^--"- -- -- ..--, 9161+ �+ �6K n"7f AN q- "_' �,__....rH!IH 1MLi O - --- Pages cc I4225 SHdgo Ln.CL*hcgue,NY 11935 I (631)734.6585 !'!Kdlk Coupty Consumer Affalm ` f�•'f�'•+/r, fir, I i I I � I .•�^ �rp- �E •' /oo u � �S 5 10 AlAke-1- N CGirar�r��✓a //�-C l� i