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Fisher, Robert
��d( � I;I,IZA�ET}�A, I�1�VII�LE,1i�1�C �° Town Hall,53095 Main Road �p�� �I,��� � � P.O. Box 1179 � Southold,New Yorlc 11971 REGISTRAR OF VITAL STATISTICS � FaY(631)765-6145 � MARRIAGE OFFICER ��° Telephone(631)765-1800 � RECORDS MANAGEMENT OFFICER �� www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER ���I�� ����� ���� ��.� � TOWIV OF SOUTHOLD TO: Southold Town Building Department F�OM: Carol Hydell, Southold Town Clerk's Office DATED: August 15, 2016 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 4416 for a Cesspool/Septic Tank Construction Permit submitted by: Mark Schwartz for Robert & Noreen Fisher 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 a�roval required from the Suffolk Countv Health Department Signature Dated o�oSu�Fac�-�, ELIZABETH A. NEVILLE �`Z` OG•f. Town Hall, 53095 Main Road TOWN CLERK p � P.O. Box 1179 REGISTRAFt OF VITAL STATISTICS y Z Southold, New York 11971 MARRIAGE OFFICER Oy � �� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER � Telephone (631) 765-1800 FREEDOM OF INFOR.MATION OFFICER �0'� � �a 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 1�or Non-Residential @ $25 Application No. �� � Permit No. Applicant Name Applicant Mailing Address � �� �� � Septic Tank or Cesspool Brief Description of Proposed Construction or Alteration ��� Location of Proposed Construc i Alteration: Owner of Property: � �U��I � / `�U�`L°�� Owner Mailing Address: � � � � Owner Property Address:_ �� �� (�� �����c�C, �/V� �� ��,.�� Naine and phone number of contact person Tax Map No: Section t r � Block � Lot � Cross Street ��(A ���� � I�tOT'Ee I,OCA'I'IOI�i IdI?.I' iVIITS'I' �E SIJ�iVIITT �I APPI.ICATION. 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Ap�i114,2U1fi REINfORCING70R�}ISYi+NApPtIHDFORCCOF300y:f. t),A,V�WVdUMUISffh'C�BEN7EENLGACHII�GPOOLSAN7U7A7ERLINESHA6'-_BE � 3 -.,,,,.nM,..a....�-..�r�----� --��� � ' -"""�' " '"-`"' � - r.�tniNTsirvEo. exu-nuceoei: esa>so Fr z.o�i� -=p, .."�H *� ,-„�^_. . �_.� .:�_�.��.�w, _ �HEL'f'aUn�fBER: A)TILNI\(S<.HALLe3E`f;rilfl�SplH%:I"fH�IA'JY.IS1VATtRTIGNI. - ,�, �. ..,.,�„ _ _e ... ; ,)AN 8'MI?� UISfrNC�13ETV'/I:Lh!/�Ll LI:ACFiING VOOLi\h!D 5'c�IC TA\K 51-iAL! FXISTING PooL UE[K: I�1,o S2�T. a.%9L �~� . �),�:ifSEP�ICThNY.S':A�I LiM1STALLNniINCI�tvA:-�UIRi�TIONS�vJIiHi\ pE7.1A1'vfANED � MAX TOL�RAN£E OF-i�i;�i"i ON A NInIMJiv1 3 ;HIC'K QED Of CO,viPACTEb � ` ".." '. " '^' ` "' .`" ` ". " ` '" "' ".�','"`��_ � SAIVJORp�1G AVE�. � �, .- - ; . 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