HomeMy WebLinkAboutSullivan, Richard SO JTHCLD WSTEV1ATER DI SPCGAL PERM T
CCNSTRUCTI CN CR ALTERATI CN PERM T
SEPTI C TANK or CESSPCO-
Per m t Nb. 3927 R Resi dent i al X Nbn-Resi dent i al
Fee $ 10. 00 Septic X Cesspool
PERM T I SSIJED TO
Nano : COASTLINE CESSPOOL
Address 1: 4225 BRI DCI LANE
O t y St zip CUTCI-IO2 E NW 11935
Ikscr i pt on of Proposed Const r uct i on or Al t er at i on
Al]] TI CN TO EXI STI NG SYSTEM
APF93 ED AS SU3M TIED Mal WAN RECD RED SETBACKS FROM ADJACENT
WELLS, BU Lq NCB, PROPERTY LI NES AND VATER BCD ES.
EXCAVATI CN I NSPECTI CN RECD RED
Nano Cf OnAner R CHARD SU-LI VAN
Mai I i ng Address 1 P 0 BO( 75
a t y St Zip NEW SU=FCLK NY 11956
Property Address 1 440 3RD STREET
O ty St Zi p NEW SUFFOLK NY 11956
Tax Map Nb. section 117. 00 bl ock 9 I of 20. 000
0 oss St r eet JACKSCN STREET
Bui I di ng Per m t limber O oss %f er ence:
I ssue Dat e: 1/ 15/ 10 Elizabeth A Nevi I l e
Sout hold Tow O er k
(TOM SEAL)
,se'o� OF SOUlyo.:
ELIZABETH A.NEVILLE,RMC,CMC Town Hall,53095 Main Road
TOWN CLERK 411 l�[; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS G ,�
Southold,New York 11971
MARRIAGE OFFICER �',��► �O �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ��`, ,�� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER OUNTr, ���� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: January 15, 2010
Transmitted herewith is a copy of application No. 3927 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Coastline Cesspool & Drain Service for Richard Sullivan
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.
Signature
Dated
%01 suFfot,�410
ELIZABETH A.NEVILLE d ,�`1` y ; Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v Southold, New York 11971
MARRIAGE OFFICER : �+ Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER '.. 0.0 Telephone (631) 766-1800
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 @$25 Application No. 3 9 R
Permit No.
Applicant Name G( Q \ SS DCQ C�J��C .
Applicant Mailing Address �`\oQ -3 Sc=kciqe
eA l'cc ncyye_ k) \cl3
Septic Tank or Cesspool ✓
Brief Description of Proposed Construction or Alteration _�1 1S�Q�\ 3' h. X
Cx?€(C--\lamporn
Location of Proposed Construction/Alteration:
Owner of Property: Cll cnosc .So\ \\'iCI fl
Owner Mailing Address: C-ick—lFJ
'N 3 3 A\s Nl l\alio
Owner Property Address: - kC) 3rd 5*c-ee '
Name and phone number of contactperson \ �l -q O - 1'536;1 ( 02_0)
LLa\ � �l�n 3
Tax Map No: \O00Section \ \--\ Block a Lot a
Cross Street fIC S(-x, Seek
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES _ . ° Y WITH HEALTH DEPARTMENT APPROVAL
i \ 13\\0
'1. ature of Applicant Date
Received by: 67f a-6
• 11
t
t f j 4.., ....... MAP OF PQOPEUY
POLASHOCk. r----
SURVEYED K' .
w a.'14' 0 fF . SJLLIVAKL. ,
r<1f S.S6aQ •
5C�`E2.0° J LY AT
r.-- CYCLONE PEN. 6.- r L,.
2 „ ,t ., I NEW FF
I CHIN. Nal TOWN OFOUT LP,N:Yik ,
i Ft2. a-tac./Z
oft
r.` i ; N rFi4E0 •
N . . ..
�RrI
, , bi ..t. ..... ....... ........t.................4
-- 0SC1c G,loch r.01
616 t..., GA14.
. QNAUtwORIzw AL ATION OR MDKnOS
r'+��1'►7 f TO THIS SURV I IS A VIOLATION Of
IEGT(ON 770D OF THE NEW YOIIR STA$
`'r-' pOe ' / (DL AT W LAW,
N� rC/O� w I; COPIES OF THIS SURVEY MAP NOT REARIMG y
z �/ (!•IE LAND SURVEYOR'S Rl(ED SEAL OR . J' P • 0�3 I
<y f in IWOSSED SEAL SHALL NOT IE COMMAS w.e,
oat,. 3/= X$ 1"' . ) EO BE A VALID TRUE COPY. �!} ��
I' �+ { GUARANTEES INDICATED HEREON SHALL NM "'( Ow T
V I ( , -1 ONLY TO i PREPARED THE
AND ON HPERSON OTS IEHR AOLF TO/MEM THE Er T
t (iTLE COMPANY,GOVERNMENTAL AG&K'! AN, '
\e\-
\ a LENDWG INSTITUTION LISTED HEBRON.MID
( P _- - -» 10 THE ASRIGNE5S OF THE LENDING R 1- .
1N•- /— ` I �J7t�Q�( Y r`l tato*AUARAMTRII ARE NOT TRAN>!ERAe,
-1 TO 9tDDI1Io'Idlil INIT'MEowc'- uasFo
1t7 -__.. ---...--i I vj MAP AMENDED 5EPT. it tg$B }
N.85.40'304W,
• GUARANTEE* To r x ,.,.,.c', .. '_IT T' T it.,.4 :.,
JACk:.5ON STQEET -41 1141` . M .aci wr, r _ " '� " , 4. i'
+.5 SUR.VEYED JAN.21 1983
E1•
..1C VAN I Y .., ,
T
V
•Z _K..QOUNTY TAX MAP CgBIG A `TLQ LIC.LAND SU RVEYDRS - GQEENPO(ZT( .Y
DI 5T. 10001_SECT.,1 1 7 , BL.k: 9, PCL. 2D.
` }
{
.