HomeMy WebLinkAboutFaria, Loretta SCUTHCLD V1ASTEMATER DI SPCSAL PERM T
CXNSTR CTI CN CR ALTERATI CN PERM T
SEPTI C TAN( or CESSPOOL
Per m t No. 4135 R Resi dent i al X Non-Fesi dent i al
Fee $ 10. 00 Septic X Cesspool
PERM T I SSLED TO
Nbrre : LATHAM SAND & GRAVEL
Address 1: P O BCC 608
City St Zip PEOCN C NY 11958
Descr i pt on of Pr oposed Const r uct i on or Al t er at i on
Al]] TI CN TO EXI STI NIG SYSTEM
APPRIED AS SU3M TTED Mal NTAI N FEW RED SETBACKS FRCM ADJACENT
VELLS, BU LEI NLS, PROPERTY LI NES AND MATER BCCI ES.
Name a G ner LU4I ITA FART A
Mai I i ng Address 1 1911 BEDFORD AVENLE
Ci t y St Zi p NORTH BELMCRE NY 11710
Property Address 1 535 SHORE DR VE
City St Zip CPEENPCRT NY 11944
Tax Map Nb. sect i on 47. 00 bI ock 2 I of 16. 000
Cr oss Street SI LVEF ERE RO tkD
Bui I di ng Per rri t NUnber 0 oss Ref er ence:
I ssue Det e: 6/05/ 13 D i zabet h A Nbvi I I e
Sout hold Tow, Ci er k
1
T
ELIZABETH A. NEVILLE,MMC i, ;_a l/,j,\ Town Hall, 53095 Main Road
TOWN CLERK %% C P.O. Box 1179
t c/3 2 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ; v' �t
O .v Fax(631)765-6145
MARRIAGE OFFICER .=4� ��
RECORDS MANAGEMENT OFFICER Q( * %0•••� Telephone oldt nny.gov
FREEDOM OF INFORMATION OFFICER --• ...,..10��� ���•southoldtownny.gov
OFFICE OF THE TOWN CLERK..._. _____ ----TT-7---�
TOWN OF SOUTHOLD ' ' '
TO: Southold Town Building Department ; ,'„ Ay i l 2013 , .L;`I
J 1. i
FROM: Carol Hydell, Southold Town Clerk's Office _�_ ,
L
DATED: May 17, 2013 ._ ----
Transmitted herewith is a copy of application No. 4135 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Latham Sand & Gravel for Lorretta Faria
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. Thank you
* * * * * * * * * * * *
I have reviewed the application and ation 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
z:) 3/3
Dated
,
ELIZABETH A.NEViLL E t�� Town Hall,53095 Main Road
TOWN CLERK i 1 P.O.Box 1179
REGISTRAR OF VITAL STATISTICS Igo 4 ; Southold,New York 11971
MARRIAGE OFFICER ir FaX
Fax(631)766.614$
RECORDS MANAGEMENT OFFICER .�0�,�' Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER ` _I_:I �!;,•'' 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. 9 I 3
Permit No.
Applicant Name John Hock e/ L hm Sgt-+ 609 Ve )
Applicant Mailing Address ' ) , X 6dg
',pcoo,c, f)cI 095g
Septic Tank ✓or Cesspool i-
Brief Description of Proposed Construction or Alteration rep/Hcc Selo+i -An L+
Cess IS 0 Sv[folL Coon- /IDA/-th ser�rc yec cA-bons
-� y
Location of Proposed Construction/Alteration:
Owner of Property: LOrr2 i FA rt H n
Owner Mailing Address: i9 i/ todTcird%02 no Q
rw-1-h —1 ry-nre, (c( Int 0
Owner Property Address: 535 Shore Dr)UJQ
Greer)p(-), (lY 1044-
Name and phone number of contact person J?)hr HOCA/ 63 f ' 4- 6 CO
Tax Map No: Section 4c7 Block Lot / 6
Cross Street S► /VO,'(Y)eYP -�--UHC
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY Air' HEALTH DEP TMENT APPROVAL
/4
l'il .5e 5/43 .
CA/'
Si , : i 1, of Applicant Date
Received by:
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