HomeMy WebLinkAboutSchmidt, William SCUTHCLD VIASTEVWTER DI SPOBAL PERM T
OCNSTRUC"TI CN CR ALTERATI CN PERM T
SEPTI C TAN( or CESSPOOL
Perm t Nb. 4104 R Fbsi dent i al X Nbn-Fi si dent i al
Fee $ 10. 00 Septic X Cesspool
PERM T I SSLED TO
Nene : MRI S CESSPOOL SERA CE
Address 1: 2760 YEMEOOTT DRI VE
City St Zip SCUTHCLD NY 11971
Descr i pt on of Pr oposed Const r uct i on or Al t er at i on
ADDI TI CN TO EXI STI NI3 SYSTEM
APPR vED AS STEM TIED MNJ NTA] N RECU FED SETBACKS FROM ADJACENT
VELLS, BU LII NCB, PRCPERFY LI NES AND MATER BO] ES.
EXCAVATI CN I NSPECTI CN FEW RED
Narre Cf Other VW LLI AM SCJ-M DT
Mei I i ng Addr ess 1 4500 VESTPHLIAFD
O t y St Zi p MkUI TUCK NY 11952
Pr oper t y Addr ess 1 4500 VESTPHALI A ROAD
Ci t y St Zi p WTI TUCK NY 11952
Tax Map Nb. section 113. 00 bl ock 11 I of 13. 000
a oss St r eet BEMETf POND LANE
Bui I di ng Per nit Nunber Cr oss Ref er ence:
Issue Det e: 8/07/ 12 Elizabeth A Navi I I e
Sout hold Town a er k
(TOIWJ SEAL)
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ELIZABETH A.NEVILLE,MMC s� � 4 Town Hall,53095 Main Road
TOWN CLERK 4 p P.O.Box 1179
y Z Southold,New York 11971
REGISTRAR OF VITAL STATISTICS :p .� 1 Fax(631)765-6145
MARRIAGE OFFICER : 'frs ��
RECORDS OF MANAGEMENT OFFICER ,� * '10'010'
a0 0'r Telephone(631)thfork n
FREEDOM OF INFORMATION OFFICER ��� southoldtown.northfork.net
.....iii
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Carol Hydell, Southold Town Clerk's Office
DATED: August 27, 2012
Transmitted herewith is a copy of application No. 4104 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Morris Cesspool Service for William Schmidt
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.
Signature
Dated
�
ELIZABETH A.NEVILLE 414./ �► Ct%A%' Town; Town Hall, 53095 Main Road
TOWN CLERK ; p P.O. Box 1179
ti Z ; Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �y. �
MARRIAGE OFFICER : G 1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER s'4, aO�r►1i Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER =_'� ,err southoldtown.northfork.net
-----..,.01
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10or Non-Residential @ $25 Application No. if / C54(
�J i a ,,, Permit No.
Applicant Name � � /��` 5� ,
Applicant Mailing Address 2:667;44/47/1,110rr '°e
Septic Tank or Cesspool---1 Gr:/
Brief Description of Proposed Construction or Alteration
66
Location of Proposed Construction/Alteration: �" Q �
Owner of Property: /4' i `l s ,''7/J"' -
Owner Mailing Address: 1/4.-- -7-0 4-157pAa9-/j/+- 4
mht-p i.f z '
Owner Property Address:
Name and phone number of contact person 9 ,, i,....‘ ma s FY/ Z,Jo/
Tax Map No: Section 1/,7 Block // Lot ,/,.YCross Street e N -, AD _
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SUR V WITH HEALTH DEPARTMENT APPROVAL
y),,,e,-/iieee ,,-/e,-47.., spfiz.
S gnature of Applicant Date
Received by: °41
'117 4
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