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HomeMy WebLinkAboutO'Brien, Joanne r i SCUfHCLD VIASTEVIATER a SPCEAL PERM T CCXSTRUCTI CN CR ALTERATI CN PERM T SEPTI C TAN( or CESSPCCL Per ni t ND. 4216 R Fbsi dent i al X Fbn-Fbsi dent i al Fee $ 10. 00 Septic X Cesspool PERM T I SSUED TO Barre : COSSTLI ISE CESSPCCL & DRN SRVCE Address 1: 4225 BRI DCE LADE CI t y St zi p arra-IOCJE NY 11935 Descr i pt on of Proposed Const r uct i on or Al t er at i on ACO TI CN TO EXI STI N3 SYSTEM APPROVED AS SU3M TIED NAI NTAI N RECD FED SETBACKS FRCM ADU ACENT YELLS, BU LI] NCS, PROPERTY LI NES AND VATER BCD ES. EXCAVATI CN I NSPECTI CN FEW FED Nana Cf Cooler JO NSE 0 BRI EN Mai I i ng Address 1 666 SI-CFE RAD, APT 5D a t y St Zi p LONG BEACH NW 11561 Property Address 1 350 I-I CKCRY ROAD a t y St Zi p SCUTHC LD NW 11971 Tax Map Nb. section 56. 00 bl ock 6 I of 11. 000 C7 oss St r eet SCIAD.I EVVAVENLE Bui I di ng Per rri t Nurrber a oss Ibf er ence: Issue Dat e: 4/07/ 14 Elizabeth A Nevi I I e Sout hold Tow, a er k +, 1 .,,,Io�oSUFFo��Co ` ELIZABETH A.NEVILLE,MMC ,ie E.V * Town Hall,53095 Main Road TOWN CLERK ; P.O.Box 1179 t ti 21 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax t% Fax(631)765-6145 MARRIAGE OFFICER ** 0* / Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER (II * le'olia www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER ...,,,," OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD D 2 C l p W E TO: Southold Town Building Department _ MAY - 3 2013 FROM: Carol Hydell, Southold Town Clerk's Office BLDG.DEPT. DATED: May 3, 2013 TOWN OF SOUTHOLD Transmitted herewith is a copy of application No. 4216 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Coastline Cesspool & Drain Sery for Joanne O'Brien 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. . -7.1"6-c..X---0,7 ,A,Z. Signature 3 )i3 Dated / �'4, COG Town Hall, 63095 Main Road ELIZABETH A. NEVILLE ,�'�� , P.O.Box 1179 TOWN CLERK ,. yeSouthold, New York 11971 REGISTRAR OF VITAL STATISTICS Fax.���t Fax(631) 765-6145 MARRIAGE OFFICER y it ��� Telephone (631) 765-1800 RECORDS MANAGEMENT OFFICER 01 �a I�. southoldtown.northfork.net FREEDOM OF INFORMATION OFFICER = OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK 10 Residential @ $10 ✓ or Non-Residential @$25 Alication No. t( 2(Permit do o. Applicant Name CQ(r y7\\ C0S ) \ a O'° 3 si \C Applicant Mailing Address LI aa3 bc acy \—Q - etC:x\ 9-- r om) "C-( 5\C 5 Septic Tank ,,/ or Cesspool 1.--- Brief Brief Description of Proposed Construction or Alteration Cyfy \c . \o\r co 1-h\S - C\ \c \\C M • x C\ ame-cD Ca \-1 Ir\S, Location of Proposed Construction/Alteration: p, Owner of Property: On( C) yr\-e Owner Mailing Address: Lolsl_p S`Clocc .. 'A(* `7Q \_C -Q e>9--tackl . si\_ ,--\ \\moo 1 Owner Property Address: .35c--) \--\\C__ C1"-\ (-Lc, ") o LA \ \C i Name and phone number of contact person .. 2n\\ - \to-010 - \' 3O Tax Map No:\OCOP Section d P Block (._o n Lot \ \ Cross Street `- .7.XYA1/4.helvJ NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIVEY WITH HEALTH DEPARTMENT APPROVAL � - Signature of Applicant Date Received by: ,„.: �__w, I to4dii4,p 'c,x-- ..„,..,411'... -,*,-: ,, :-,.., ..,. i T ° a f r ' 0 Oil VII ° <` ' ,, "a'` t 4T i © C + l \/V I icits " —.- 0 i ,/ , . , -cit J )1,... -D '""� 1„ M pipe ' t ��/ a > 4 s`" z z ` .« ate ..., .�y,� f i 1Mi, 1RYf :MI': 't 4 7:olisisor726tios°Psuiverlit M, HOT tAmNIG +e a A*. y so4'1 # 9 tj M 1 1YO S iia'CR -° - rc ct or "` �.- IQ if A-YAW`i E GO►Y* avAttaions oft1 to fl lt ftfES 7W fait wNOM►1Nt lI1tYft p .? •'"'� 'AP 7/ is �w ` [ „,,,„. •lit M to fty” UC }^Sk �L -% rl "s� .3 . a sK z v !1 r,>