HomeMy WebLinkAboutPurita ELTZAEETH A.NEVILLE,MMC �y� �.y Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
coo 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
DD OFFICE OF THE TOWN CLERK o Mc��adR
TOWN OF SOUTHOLD
DEC 2 2016
TO: Southold Town Building Department BUILDING IDM.
TOWN OF SOU TOL D
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: December 2, 2016
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. C4448 for a Cesspool/Septic Tank Construction
Permit submitted by:
Nancy Steelman for Claudia Purita
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 County Health Department
Signature
"q D
Dated
r" M f Vk/��p
ELIZABETH A.NEVILLE Town Hall, 53095 Main Road
TOWN CLERK P.O.Box 1179
Southold,New York 11971
REGISTRAR.OF VITAL STATISTICS ♦Y �1
MARRIAGE OFFICER iP Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ��® ��� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER '� 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. g
Permit No.
Applicant Name Nancy Steelman
Applicant Mailing Address 25235 Main Road, Cutchogue, NY 11935
Septic Tank
—7
Brief Description of Proposed Construction or Alteration Build new SCD iS apprnvad gystam
Location of Proposed Construction/Alteration:
Owner'of Property: Claudia Purita
Owner Mailing Address: 19995 Soundview Avenue, Southold, NY 11971
Owner Property Address: 5415 Old North Road, Southold, NY 11971
Name and phone number of contact person Nancy Steelman 631 734-6405
Tax Map No: 1000 Section 51 Block 3 Lot 4.11
Cross Street County Road 48
NOTE: LOCATION MAP MUST BE SUBMIT D WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SUR WITH TH EPARTMENT APPROVAL
11130&
ignature pp cant Date
Received by:
I
REVISIONS
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II SCTM# 1000-51-03a.14
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— \\ OWNER' Claudia Punta
19995 Soundview Ave.
— I I F 1 1 \ Southold,NY 11971
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5 TE #1 TOTAL SITE AREA: 25.1943 AC
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EW YORK 11971
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SITE 5•
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- __________________ 35
PROPD N 66 033054 NE0.34 NO IC, OM4 SY5TEM #2 0
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FT DIA x 12 FT HT(EXP) (\ W•u W
EXPANSION POOL
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SuHolt County DepanmwtofHWlh Sc .
Appmval far Conseucnan-OltneThan Sml'amily y Ito-
ge
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I \ County DepanmentofHwhh Suwces staedards relaung to wztusupply
\ \\ \ I and sewage d,xpnsal Regardless ofany.—nes,Mon Mm=
or II
Co.muelmn tP regmred Io M m accuda fi tnily waived by SPIE CF NEIV
\ \ perme mndmona a, a V Ile stands 7 yenalm fwm the approval data, o FF 9,F
the Department rued a
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2'DIA,54'BELOW GRADE ex l•t "��::
App .IDateReR
r�
I \ \\ \\ 1 r BXISTIN6 UNDERGROUND (I—
ELECTRIC 6 UTILITIES LINE
PROJECT fj 0701
SGVHS _iA7 DRAWN BY.
GRAVEL UT
CHECKED BY
NS
I \ \ \ I RPZ DATE
July 24 2015
\ \ / SCALE
s m
SHEET TITLE:
SITE
\W TW I ; m P�S�G1r1ATER UTILITIES
z 1 1 \ sol
I(1 N 1 \\ \ ow9 \ I i MNN IN ROAD
m 1 1 PLAN
IbIS3' \\ ` - -34 I i G:CM;ATIONINSP�CiiCTl REQUlsS
z \\, H 66 03'30 11\ 32 33 EOR SANITAR`l 3YSTG1
30 31
EY HEALT71 CcPAF i.1'I!T
F'o F SHEET NO
—— i Water Line(G)MUST Be Inspecicd By The 2 Z�,�
Suffolk Count)'Dept Of Hours
IHealth Services
Call 652-5700,48 Hours h Advance,`6 -Go HATH ScRVCES
'nI I T°Schedule Inspectlon(s) F{L OF1'ASTE,-1,R 7,T
L- 11 VLA ``?/ ® Il 1� LA tl V
SCALE:1xr=20-x-0" I SCDHS SUBMISSION