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HomeMy WebLinkAboutBondarchuk • ems+ ELIZABETH A. NEVILLE,MMC / L Town Hall,53095 Main Road TOWNCLERK �� - 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 :,z 1 * www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER "'- / OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Carol Hydell, Southold Town Clerk's Office DATED: July 20, 2016 Transmitted herewith is a copy of application No. 4408 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Latham Sand & Gravel for Edward Bondarchuk 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 +4 OFFoc,-1;. ELIZABETH A.NEVILLE 0', O4\ Town Hall,53095 Main Road TOWN CLERK O : F.O.Box 1179 t 00 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS i tY n? MARRIAGE OFFICER ��� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ;4�►Q a4$ ►� Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER =_ Dt'I southoldtown.northfork.net OFFICE OF THE TOWN CLERK • TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 _ or Non-Residential @$25 Application No. Z Permit No. GCA6791./C2� Applicant Name �;��7iD. ,�. �/�`ch�J a 4R �� Applicant Mailing Address_ _Box ® 6150 11 Septic Tank.< or Cesspool Brief Description of Proposed Construction or Alteration / i) / . .. c.-. ce ) 6 - g 049°)Z *Pp 40 .1Ail_ (oondo tb,c2914. --oppi - 4 p)(01 . Location of Proposed Construction/Alteration: ,fid Owner of Property: J. C� Owner Mailing Address: (5O 73102 )ion t S 04-ho 121 0Lk y9 0 ) Owner Property Address: ).5(''') 1012 Choc) �✓ LILA Name and phone number of contact person Tax Map No: 000 Section 59 Block / Lot Cross Street l A c- NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY V;G- ! P NT APPROVAL Si a ature of Applicant Date 2,z 6. Received by: .-..-Vil, 1 l• ,1\iC%\.. . D 4 / // ' L. -\-- `b / •0f PPVENEtS1 5�/ pGE 'ems / • \ \� P°1� O four. tJ `3\11\t. S f�,Di�R � '\OQ 0 P\PE �� a V- ONEi. fO°E 04S 0.3� ..* ' � NCE' \ W, NOTES: • Ft i e *000 f \ ..A. 1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1i '� Ar TEN EXISTING ELEVATIONS ARE SHOWN THUS:s cE 'ur 3 S s \ \ ,• F.FL.- Flaw Flinn 1kG.N ' a d. ,443 ° ! i�� \ O T B'- TOPGARAGE FLOOR C° o C ' ° I 1 \ 2. FLOOD ZONE INFORMATION TAKEN FROM: zBUUCHEAD a%I 4q \ r FLOOD INSURANCE RATE MAP No. 36103C01: 1''� ZONE VE: COASTAL FLOOD WITH VELOCITY HAZ/ !�m 9 -� �+ \ BASE FLOOD ELEVATIONS DETERMINEI W, �e =I O \ ZONE X*: AREAS OF 0.2% ANNUAL CHANCE FL �. w: `� WITH AVERAGE DEPTH OF LESS THAN � \ 1 SQUARE MILE; AND AREAS PROTEC 01. \ . . 1 \ ZONE X: AREAS DETERMINED TO BE OUTSIDE T O I \ W \ . \ \ n :-041 \ \ i : �.:' \kii - \ S').\\'' :,;') \ paa ., \ / st \\ aa , 4 r 4 g �\. \ �3 O \ G tF \ fig \ a� 4�� AR \ \4``o ,o, ° sys 9,9 \ a 2©A/ �-- `oRc"� I ' a�P,00 Q X 28,4 s?. \ ,� ppFetoN Co140.1,-- g 0:E�yjl- c�7' 111T SUE y r.°i ``4 F-1- -4-o m o y �. l�� J__►O P�, 1,D io 1S1OR:1:i p`R�G� �z � 1-�� _S THC :a� Z 45.6 -//'f � � £�� I fE3 c""r�c FIDE No. 3853 'o o� //j.✓ SIT Mo 1-� �2" � Pte'"ER \\ 1�1 6,S 1 1. 1 FVCE r o N R \ 0 lo�� v � ,�� �' vV :,r, 04 SUFFOLK C( -n S.C. TAX Nc 11 I ac � - to SC 4 n I N \ JU , R k JANUARY 3 it �j ,� go�H �"\GNwPj� 1' FEBRUARY 10, 2Q16 ADI TB' A"°N 1® AREAy t q9 \ (TO :0111\51D BULKHEAD Jar 91® W ®®9. Ns... 21clo Y 4Pclael.2s-6Pcx)15 \S\--,- CERTIFIED TO: 1 EDWARD J. BOND �, , r.nMMONWEALTH