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HomeMy WebLinkAboutKrstulovic, Stephanie I SCUTHCLD V111STBAATER q SP06AL PERM T CONST UCTI CN CR ALTERATI CN PERM T SEPTI C TANK or CESSPOOL Per m t Nb. 4172 R Resi dent i al X Nbn-Fbsi dent i al Fee $ 10. 00 Septic X Cesspool PERM T I SSIED TQ Narre : 00%9111W CESSPOOL & DRAI N Address 1: 4225 BR DCE LANE CI t y St Zip curcHccIE NY 11935 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 NG SYSTBUI APPRCXED AS SU3M TTEQ MSI NTAJ N REOU FED SETBACKS FROM ADJACENT YELLS, BU LDI NGS, PITY LI NES AND MATER BCD ES. EXCAVATI CN I NI,SPECTI CN RECD RED Nana Cf Owner STEPHAN E KRSTLLOA C Ii Ii ng Address 1 609 VEST 114TH ST 62 CI t y St zi p NEVVYCRK W 10025 Pr oper t y Addr ess 1 335 SOUTH ER VE Q t y St Zi p NATTI TUG( NY 11952 Tax I,bp Nb. section 106. 00 bl ock 11 I of 19. 000 Cr oss Street BAY MERE Bui I di ng Per rri t NUnber Q'oss Ref er ence: Issue Date: 1/02/ 14 Elizabeth A LevilIe Sout hold Town Q er k ,/ ,o\,gUFFO[,r�o ELIZABETH A. NEVILLE,MMC 1/4y► l/,j,\ Town Hall, 53095 Main Road TOWN CLERK o A 1 P.O. Box 1179 H 2 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p Fax Fax(631)765-6145 MARRIAGE OFFICER `�y ���� Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER -791 -0„ www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER �' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department OCT 2 5 2013 FROM: Carol Hydell, Southold Town Clerk's Office DATED: October 24, 2013 Transmitted herewith is a copy of application No. 4172 for a Cesspool/Septic Tank ALTERATION Permit submitted by: 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. * * * * * * * * * * * * 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 /6'4-0 Dated 1', $vrll 0 - _ ELIZABETH A.NEVILLE ;, * \ Town Hall, 53096 Main Road TOWN CLERK A ` P.O.Box 1179 '` Z ` Southold New York 11971 REGISTRAR OF VITAL STATISTICS t ' MARRIAGE OFFICER '�10 Fax (631) 765-6145 RECORDS MANAGEMENT OFFICERa0�e'' Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER = '� *''�'+.'0 eoutholdtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT • APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $10 V'or Non-Residential @ $25 Application No. of 1'1 Permit No. Applicant Name CQ \\nQ `1n��� C 7\ c' am \n .S'x -e__�� (?. Y `C° Applicant Mailing Address kcie-At. L) . • e svc-tr,ce A- \ \\ \ Septic Tank ✓or Cesspool , - Brief Description of Proposedonstruction or Alteration_' \\ C 1> \(-)._-iTh c 11 Se &c° 's-r�.�\< C 1� 6X 1, - \ecic \ c—^h\ Location of Proposed Construction/Alteration: Owner of Property: . Y\C3c(1\� 1 \C-SA-0\CA) \C Owner Mailing Address: -Q CR W05--\-• \\ SSA , L4 a v. c . i.._ ____\ \c-i--) ,5 Owner Property Address: 3.-. --, St`x) r\Th Of: \Vt? Name and phone number of contact person L \\ Ch Y K - '--)1U - ,. —+ Tax Map No: \O00Section \C ko Block I ` Lot (a Cross Street u \ \ (1 X NOTE: LOCATION MAP MUS BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRE URVEY HEALTH DEPARTMENT APPROVAL f ( .--4-'1005‘.) G. , - VD-22-- 13 \ litre of Applicant • Date • Received by: `' 1-� ,OT® — \\� t�` /1°5 TOP OF BANK�� .........---..-..-.2.--,-..... � 7 / --,'1' I ��jx , J.2, \`\\� Io)4 I ' N,,,,\\\\�\\�' atm.N 47.28' 4 13.4 v- / c : —.. _. ._ .. — . .— .._ . . 6 ASO" x / - AKA, OVERHEAD WIRES . UPON CUT N �� �� POLE WIRE \' / 20t* \\ �O \ : x 4�� pik- i rWOOD BULKHEAD \ \ /ir- 20.6 T�, 14.8 •;:: b ' iii: W : OIRT srEPs 14•.,►i C / io 1..... SHEDS LE dt//�/ p '� = ' 20.6' l il O p/ ��wooD�= a< SOD a DIRT -� SHED SZi�[ \i ..N . til, *. • STEPS a o WIRE = .y qr� ��,�1� 2),3 41 y INCE AROUND _ -- .A r: CARDEN AREA • d p 'A 1. • ` +.'0 :t,., Qe 4L /ROVCH • ° \ 1104 • es� ��J :�< 1 STONE I///lid v .00. SS • PAT/0 mow 1 • NM i' ji �;N i � i Fa • - ... .. *A.. taa 42 i_L-- IA - 0.4 '0' .:1,;•. 1 W000 �/ •t fn • wP •N B• i , ' WALL 0.7•N.i PLATFORM CIL; -* m PAD 1u ��ROCK WALL WALL O. N w +� w w " NCE�w CHAIN IJNK FENCE-d FENCE 1.8•S. .4•S. 'a , Z /./ Z //e- /r '::.-C"-Z--...C/7`",‘c 7 . •>,.... -7: LOT® ..d/� ,S.---/, 71.67- 1-7 /429 6,4= 5,- ' ' e.,0g�so.✓ " (FAV / .0 /'. 'eVe ,1%e,/ 6/;. "- t•/--- 7 /�O # i