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HomeMy WebLinkAbout13200 Main Rd Corp � . , -- , - �����FFOL���� , ELIZABET�I A.le1EVILLE,IVIMC �� � Town Hall,53095 Main Road TOWN CLERK �- � P.O.Box 1179 � �' Southold,New York 11971 REGISTRAR OF VITAL STATISTICS � � Fax(631)765-6145 � ' MARRIAGE OFFICER °�'� ��°• Telephone(631)765-1800 RECORDS MANAGEMENT OFFTCER �� � • � www.southoldtownny gov FREEDOM OF INFORMATION OFFICER �f - OIFFICE OF TH��TOWN CLE1�K TOWN OF SOUTHOLD � (���0(�/J� IS v D TO: Southold Town Building Department �UE " � 20�6 FROM: Sabrina Born, Southold Town Clerk's Office ��������8 TOi�O�SO OLD DATED: July 7, 2016 � , RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 4401fi1 for a Cesspool/Septic Tank Construction Pertnit submitted by: � ' - Anthonv Palumbo for 13200 Main Rd. Corn. 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 Comments: Final approval required from the Suffolk Countv Health Department r � , - Signature - � 3� �0/6 Dat .: � o�oSUFfot,��, ELIZABETH A.NEVII�LE �`�` �Gy� Town Hall, 53095 Main Road TOWN CLERK � :� P.O. Box 1179 y 2 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS es� ns MARRIAGE OFFICER � • `� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ���d ��0� Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER � southoldtown.northfork.net OFFICE OF THE TOWN CLEI�,K TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERNIIT CESSPOOL or SEPTIC TANK Residential @ $10 or Non-Residential @ $25 � ApplicationNo. �� Pernut No. Applicant Name T�oN 7'• � �� �o Applicant Mailing Address �• �x � /�`� 4 v� /c //�j�'� Septic Tank�Cesspool ✓ Brief Description of Proposed Construction or Alteration � �,� �,����� /� .r'Y r�.�, Location of Proposed Consiruction/Alteration: Owner of Property: � �� � �r� ��7 ° Owner Mailing Address: `7 ��� ��� �f�,�..k ,,�� �� g�'� - Owner Property Address: ��r,�p� ��i✓ �r9�� � �7�v� �So? Name and phone number of contact person E � I o 6- 3��3 �.�vY Tax Map No: Section 1 � Block �� Lot ! • 1 Cross Street <<i�► -S'uF / e-F_ NOTE: LOCATION MAP MUST B SUBMITTE WITH APPLICATION. 1�W CONSTRUCTION REQUIRES SUR Y WIT DEPARTMENT APPROVAL . — ��"�� Signature of Applicant Date Received by: , � �- .,-- � --- _ � - -- - -- - - __-�-__..-, 1 i I � S.C.D.H.S. APPROVAL ; � � � � � ! i EXCAVATiON INSPEC'FiOPd 12EQUIR�D � �GR SANITARY SYS'L'ENi ! BY�-LALTH I�EPAR'i'MENT � � i ' ..__�.,_�.�-�°-�'_ rt;S i F,E''Ti:�Kt.i �l�r�12726 � SUbJ�CT'1'G VGV�i•;�+i�'i'S �;i .�-.-.------- ;l1,G� 373 i c7�fo2, i Dt� �redi�5 -�raas.�rr'e� �rom Sevf'�,o�a ��`� - �an� .,._�,.,,�,,,,�.. � Suffolk County Department of Health Services ' Approval far Construction-Other Than Single Fsmily � Reference No. ���'►`�- d o 0 3 3 � Design Flow ���� ' Use(s) �iXP� ��t� � � These plans have been reviewed for general coaformance with Sutfolk � � Couniy Department of Health Services standards,relating to�vater supp(yj i and sewage disposa). Regardtess of any omissions,inconsistences or lack { 1 of detail, construction is required to be in accoKdance with tha attacl�ed � peimit conditions and applicable standards uniess sgecifically waived by the Depariment. This approval expires 3 years from the approval date, unless extended or renewed. 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