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ELIZABETH A.NEVILLE,MMC O (�� Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
co Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 0 • Fax(631)765-6145
MARRIAGE OFFICER ,� 0�. Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER �0� �`� www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
D
TO• Southold TownBuilding Department D
APR - 52017
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: April 5, 2017 BUILDING DEET'
TOWN OF SOUTHOLYD
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4471 for a Cesspool/Septic Tank Construction
Permit submitted by:
Rachel&John Cashwell
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.
2
Signature /
Dated
OG
ELIZABETH A. NEVILLE �`�� yr� Town Hall, 53096 Main Roa,
TOWN CIE RK p _ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
Southold, New York 11971
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER y�fo ��� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER "� �` southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
RECEIVED
`l SOUTHOLD WASTEWATER DISTRICT
APR - 3 2017
"A , APPLICATION
CONSTRUCTION or ALTERATION PERMIT
Southold Tom Clerk
CESSPOOL or SEPTIC TANI{
Residential @$10 Or Non-Residential @$25 Application No. y 4171,
1 ) Permit No.
Applicant Name 20 Ch� C0-sn VW e')f
Applicant Mailing Address 1 09
6-1 v-d Cl N lr 1 Y-3 C)
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration N 2'W Rzs ld<-�OLQ h p ry)c
Location of Proposed Construction/Alteration: pp
Owner of Property:_ � � �`fin �- ���� l�a�S �W PJB I
Owner Mailing Address: 1 a q
Owner Property Address: yIR b
U 176 0) 153
Name and phone number of contact person q Ch fd 7L S.321 b y 00
Tax Map No:1 D 00 Section f Block OR Lot 0-3
Cross Street �1_nd
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEVA
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT�AQPPROVAL,
Signa " e of Applicant Date
Received by:
ZONE f et, 1441,
pE•c Opp U nNc'�m BAr n° N
614
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46
Hq�B =g 44
i°%ST �o
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Lt?$ Covere3ge;
•h o 20,000 sq ft x 20% 4000 sq ft rax
Swimming Pool 720 sf
Frear Deck 868 sf
N INSPECTION REQUIRE® Front Deck 165 sf
44' 011.
ASF/ sB• �,yq FOR SANITARY SYSTEM House 2000 sf
�P/i� �,s' 00, BY HEALTH DEPAR-RAENT Total Building Area 3753 sq ft
/fq�'FR
-
R� PROPOSED LOT COVERAGE
I SP
SUFFOL: 'COUNTY DCPARTMENT OF HEALTH SERVICES 3753/20000 = 19%
PERMIT FOR APPROVAL OF CONSTRUCTION FORA
SINGLE FAt4ILY RESIDENCE ONLY
NT
' BELOW SURFACE �
DATE 3 1911-7 REF. 0 P2ci—t7--0001
APPROVED b
FOR AXI�IUM OF BEDROOMS ���-OF NL
EXPIRES THREE YEARS FROM DATE OF APPROVAL roo�
A
ROM NA VD 88
ba??CiLtii"+.�c�r�r of e:� s?�z�g saTYitary system must be in
LOT NUMBERS REFER TO "MAP OF HARBOR LIGHTS ESTATES SECTION TWO" cormie n"I'an-'v V!'�! requirement Submit
OM SEP77C SYSTEM FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE ON JULY 26, 1966 AS FILE NO. 4681. Completed Bor—in `° V I1 as proof. � s
A WOLAnoN PECONIC SURVEYOR
T70N LAW. AREA = 20,000 SO. ET. TO TIE LINE (631) 765-5020 Ff
. CER77FICA7IONS P.O. BOX 909
E&, 7NLY IF Or 0.459 ACRES TOM LINE 1230 TRAVELER SD
OF SURVEYOR
SOUTHOLD, N.Y 11�