HomeMy WebLinkAboutFox, Tom SCUTHCLD V1ASTE1 ATER D SPCSAL PERM T
CXTISTRLJCTI CN CR ALTERATI CN PERM T
SEPTI C TANK or CESSPOOL.
Per nit No. 4350 R Resi dent i al X Nbn-Resi dent i al
Fee $ 10. 00 Septic X Cesspool
PERM T I SS&ED TO
Narre : C04STLI NE CESSPOOL & ERA N SVC
Address 1: 4225 BRI [XE LANE
O t y St Zi p CUTO-IOCJE NY 11935
Cescr i pt on of Proposed Const r uct i on or AI t er at i on
AM TI CN TO EXI STI N3 SYSTEM
APPROJED AS SU3M TIED Mal NTAI N RECD RED SETBACKS FROM ADJACENT
V'ELLS, BU LD NCB, PROPERTY LI NES AND MATER BCD ES.
EXCAVATI CTI I NSPEC.TI CTI RECD FED
None C Ouuier TCCA FO(
Mai I i ng Address 1 975 BAY HAVEN LANE
(� t y St Zi p SCXJTHCLD NY 11971
Property Address 1 975 BAY HAVEN LANE
(� t y St Zip SCI.JTHCLD NY 11971
Tax Map Nb. sect i on 88. 00 bI ock 40 I of 35. 000
Cr oss St r eet V#TERSEDCB VAY
Bui I di ng Per m t Number CX oss Ref er ence:
Issue Dat e: 10/29/ 15 Elizabeth A Nevi I I e
Sout hold Tow O er k
(TOI('J SEAL)
,,11 TAFFOL,'
ELIZABETH A.NEVILL) MMC �;0 °pry Town Hall,53095 Main Road
TOWN CLERK P.O. Box 1179
Q3 Z ; Southold,New York 11971
REGISTRAR OF VITAL STATISTICS %,...%$.41 ��
� � Fax(631)765-6145
MARRIAGE OFFICER t Q' ,' Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER =_0I illi
,'�a0.i www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department onT 2 ,i 2015
FROM: Carol Hydell, Southold Town Clerk's Office j ___,
DATED: October 26, 2015 - - s
Transmitted herewith is a copy of application No. 4350 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Coastline Cesspool & Drain for Tom Fox
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 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. .
L4
Signature rr
16zs3 , s--
Dated
A
I/, �g,FFOI,, OG
C `` 53095 Main Road
ELIZABETH A.NEVILLE ,�'ti Town Hall,
P.O.Box 1179
TOWN CLERK . ;ti Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
Fax(631) 765-6145
MARRIAGE OFFICER `� 0. as Telephone(631) 766-1800
RECORDS MANAGEMENT OFFICER _ el `t►:0
►' eTeleph Telephone
765-18 0
FREEDOM OF INFORMATION OFFICERet
--�,,,',,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION
TI C TANKATION E�IT
CESSPOOL or EPlication No. ��
Residential @$10 or Non-Residential @$25 pp
Permit No.
eoc l 0e CesSpW/ c'0roinsuce v-
.,✓� tom'
Applicant Name �
Applicant Mailing Address CO
,
cit O! . UL- Q
Septic Tankcor Cesspool ✓
Brief Description of Proposed Construction or Alteration C /' ,/
y /' _ r
Location of Proposed Construction/Alteration:
Owner of Property: ,," 4,,
Owner Mailing Address: ' 5
5! ' 7/
Owner Property Address:.. E
lrr tN ', /55yTax Map No:/49DVName and phone number of contact person ,' Lot�—
Section_z___&___Block D
Cross Street gfZ-72
NOTE: LOCATION MAP MUST BE SUBMITTEDHHEAH EPARTMENTWITH TAPPROVAL
ION. NEW
CONSTRUCTION REQUIRES SURVEY A2:
fr.gnatUre
of Applicant Date
!) ,'.!�
Received by: # i
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VP* ill'illfr
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CSC) ,
, ,....,N.D.
0 ,., LOT 45
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V•-..) \ LOT 46 as-"N
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LOT 47
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AREA: 15,625 S.F. = 0+359 AC.
CERTIFIED TO: SURVEY OF
THOMAS FOX LOT 46
MAP OF
BAY HAVEN ,
'EASEMENTS AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED SITUATE AT
ME
I ARE NOT GUARANTEED UNLESS PHYSICALLY E17DENT ON PRE AT
THE TIME OF THE SURVEY. BAYVIEW
GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON(S)COM—
TOWN SOUTHOLD
WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF 70 THE TITLE
PANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTIONS
LISTED HEREON. SUFFOL K COUNTY, NEW YORK
_
AND TO THE ASSIGNEES OF THE LENDING INSTITUTION GUARANTEES ARE
! NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS
—HE OFFSETS (OR DIMENSIONS) SHOWN HEREON FROM THE STRUCTURES TO SCALE: 1 "=40, D,AT,E: DECEMBER 10, 2001
' 71HE PROPERTY LINES ARE FOR A SPECIFIC PURPOSr AND ill
USE AND THERE—
I FORE- ARE NOT INTENDED TO GUIDE P F EPEC DN or rrivC,, RETAINING S.C.T.M. DIST. 1000 SEC.088 BLK.04 LOT 035
wALts, POOLS, PATIOS, PLANTING AREAS. ADDITIONS TO fit LOINGS AND
'ANY OTHER CONSTRUCTION.
"rro, 407..44.1"%le
JOB NO. F3668 ...'‘
AlAP NO. 2910 M 0 Fi i--Tr”
I-1 vzo T A b-)3cD
...._,...„,. . 1 p c.
FILED:JAN. 22, 1959 - .
REt/ISIONS•
,, 4 , ' N.Y. 91.&46
-0- (631) 7 8-5330
Marc E. Charest, L.S.
Successors to
Paul T. Canallzo, L.S. Robert A. Kart, L.S.
_ license no. 050149 Good Ground Surveyors, P.C.