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ELIZABETH A.NEVILLE,MMC 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 OFFICER
www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OFT E TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Bonnie Doroski, Southold Town Clerk's Office
DATED: July 11, 2016
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4403 for a Cesspool/Septic Tank Construction
Permit submitted by:
William Toth for Mike Mantikas
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:
Signature
Dated
ELI :ETH A. LE
_,Town Hall, 53096 Main Roa,
TO CLERK P.O. Box 1179
Southold, New York 11971
REGIST' • " OF VITAL STATISTICS
"RIAGE OFFICER kt?ai, .1j77# Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER '4V71/7/ N0ilTelephone (631)765-1800
FREEDOM OF INFORMATION OFFICER * 's southoldtown.northfork.net
OFFICE OF THE TO CLERK
TO OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTE1 TION PE• I T
CESSPOOL or SEPTIC T
Residential @$10 or Non-Residential @$25 Application No.
Permit No.
Applicant Name ISL 1,k4vtt-A.
Applicant Mailing Address --f-e lq
Septic Tank 1,---or Cesspool
4 1 t
Brief Description of Proposed Construction or Alteration 7 -N1C C 1 7-"! -s
/
Location of Proposed Construction/Alteration:
Owner of Property: I k ;ticul
Owner Mailing Address: IS itJ Rds 14,4 /0 0
Owner Property Address: --
Name and phone number of contact person (
Tax Map No: Section 3 Block 06 Lot
Cross Street 0 -\41 -743
NOTE: LOCATION • ' ST BE SUBlik D : APPLICATION. NEW
CONSTRUCTION REQ 1' S SURVEY TV 2 REAL : DEP NT APPROVAL
-
1 1.1
;
Sim:4am of Applicant Date
R -ivecfby
I
I ,
'c_'- ''` RAIN R NO
CFF ALUL OSS
O PROPOSED HOUSE= 1406 s
406 x I x 0.17= 239 Cu, ft.f
239/ 42.2 =
5.6
PROVIDE I DRY WELLS 8' DIAME?
OR EQUAL,
PROPOSED SEPTIC
(FOUR BEDROOMS MAX.)
to
S 7 [i] 1000 GALLON SEPTIC TA
�� [2] 6' DEEP x 8' DIAMETER
a.rs � �5� EXISTING SEPTIC SYSTEM TO
�, ACCORDANCE
` sc WITH S.C.D.H.S.
`\ ` O .E IaOT CO' ERACE
', ` '`•• Q e HOUSE=1,406 SQ. FT.
i � SHED= 68 SQ. FT.
•� �, 0 1406+68 1393
` 41� \ o O x 100=11.0
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