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HomeMy WebLinkAboutBuck, Chris SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit NO. 4364 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : CHRIS BUCK Address 1: PO BOX 583 City St Zip SOUTHOLD NY 11971 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. Name Of Owner CHRIS BUCK Mailing Address 1 PO BOX 583 City St Zip SOUTHOLD NY 11971 Property Address 1 52650 MAIN RD City St Zip SOUTHOLD NY 11971 Tax Map No. section 61.00 block 3 lot 2.000 Cross Street OAKLAWN Building Permit Number Cross Reference: Issue Date: 8/12/15 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) ow ,l,s'.j f FOL$ • ELIZABETH A.NEVILLE,MMC ��•,ZOr 4# dry Town Hall,53095 Main Road TOWN CLERK P.O. Box 1179 Z y a, ; Southold,New York 11971 REGISTRAR OF VITAL STATISTICS v" �� � p •� � Fax(631)765-6145 MARRIAGE OFFICER %.4.. ., ' ,•� Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER : 4l * 4 0,�i www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER ,.,,,,.� OFFICE OF THE TOWN CLERK ' _.7`L___.________._ i TOWN OF SOUTHOLD 1 '' ' AUG - 6 2015 , . 'f TO: Southold Town Building Department FROM: Sabrina Born, Southold Town Clerk's Office _ DATED: August 6, 2015 RE: Cesspool Construction/Alteration Application Transmitted herewith is a copy of application No. 4364 for a Cesspool/Septic Tank Construction Permit submitted by: Chris Buck 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. Thank you. * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE r Comments: z_. - .fi.ighi. ! - 41 , , 64111WW s P77"'641, .."..r...dor. Signature 08/./0---- Dated 8'.! 0- - Dated is OFFOLts ELIZABETH A.NEVILLE,MMC , �.^� �y�; Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p R �$ Fax(631)765-6145 Qr } MARRIAGE OFFICER � a '�,�' Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER `�es' www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER ,.,,,,,.•' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD August 12,2015 Chris Buck PO Box 583 Southold,NY 11971 RE: 61.-3-2 Dear Sir/Madam: Enclosed herewith is the Construction,Alteration or Modification Permit for a Septic • • Tank/Cesspool System for which you applied. AFTER the system is installed but prior to being used, an OPERATION PERMIT IS REQUIRED. The operation Permit is issued by the Southold Town Clerk's Office. The fee is Ten Dollars ($10.00) for a residential system and twenty-five dollars ($25.00) for a non- • residential system. Your check should be made payable to the "Southold Town Clerk". An application form is enclosed. Please complete the requested information and return the application, proper fee, and LOCATION MAP (map must indicate the location of the cesspool(s)/septic tank(s), giving approximate distances in feet from any buildings to the pools and distances between the pools.. :, Should you have any questionsconcerning this matter, please do not•l?.esitate to contact this office. Very truly yours, f 4 Sabrina Born Clerk Typist Enclosures * ELIZABETH A.NEVILLE /4:' yG Town Hall,53095 Main Roaa TOWN CLERK p .� P.O. Box 1179 REGISTRAR OF VITAL STATISTICS ma%y. Clouthold, New York 11971 MARRIAGE OFFICER :.0 1 Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER !4fp O� �Il Telephone(631)765-1800 FREEDOM OF INFORMATION OFFICER - '! * •,•isoutholdtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$1 0)( or Non-Residential @$25 Application No. H 3 Permit No. Applicant Name C.(+P-IS $-vCiC Applicant Mailing Address P O . ths X3 • So'T1.1P -D, PJY ( (9 7/ Septic Tank_ or Cesspool X Brief Description of Proposed Construction or Alteration IV C'to/ GESSIltr L o vG-ri-�c--o 1-4N — 5A-ME Fo-or-Piz-inrr Location of Proposed Construction/Alteration: Owner of Property: C(IP--(s /C/( Owner Mailing Address: 17.O . Dox 5"$3 512-v7-7F©L-L � t. ' C1 `17/ Owner Property Address: 5-2-65-0 /11044-7"1 Rp 5-19-.17-11,91-13) wY I let 71 Name and phone number of contact person C ffii-t S EieveK q 7-Lf 35-—°J'!8Z Tax Map No: Section 061.00 Block 03 .00 Lot 02. 000 Cross Street OA .LA NN NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL 8'f5' !S Signature of Applicant 30 ate Received by: S.C.T.M. NO. DISTRICT: 1000 SECTION: 61 BLOCK: 3 LOT(S):2 (!) d MAIN ROAD CONC. CURB \ N60_"45'40"E 85.70'"'•;` CONCH• ��U.P. 1, CON . SIDEWALK'. 1 •• • SS....---.....- T. 85.00' I 2.8T- coi.uMN W (N pjctov�R>Jd'/w'' DI O • 1.2'W / /oy�i. 27.3 ^ - x m g j � a.o is O +' 2 STY FRM a -e4 0 ti DWELLING ' ttl Q I 2 2.5 r 152650 0 2; C a vo ce m r6 o _ f 0 o W 0. ep a 7M W oZ ZL, 8o o $ IA It �� N oo z 0 4,4vM.F.Q n 6WZ s 0' = U 15.8 Ci N 1 . 2.7'\ (' • GARAGE n N h X GARAGE 2s s ARAGE.'. 17.5'— / 3.1' ift .,.IV