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Home My WebLink AboutBreezy Shores Co-op AFF L ELIZABETH A. NEVILLE,MMC Town Hall,53095 Main Road TOWN CLERK P.O. Box 1179 CA 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 FFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Sabrina Born, Southold Town Clerk's Office DATED: July 6, 2017 RE: Cesspool Construction/Alteration Application Transmitted herewith is a copy of application No. 4493 for a Cesspool/Septic Tank Construction Permit submitted by: Breezy Shores Co-op (R. Barratt-Agent) 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 ��®SUFFOI,�t' ELIZABETH A. NEVILLE a�` � Town Hall, 53095 Main Road TOWN CLERK CD P.O. Box 1179 C4 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ��f�� ®� 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. Permit No. Applicant Name ZEEM`( SPE 5 CXJ m- Applicant Mailing Address 4- q < V 6-N S T':�, �J P-c-, A t C U TC. j Septic Tank or Cesspool Brief Description of Proposed Construction or Alteration 1ZE t— i r i-i Iii 0 i:�, -" T W 6 �j t- C'C- s;-- S- IE- Location of Proposed Construction/Alteration: Owner of Property: PA? z-Y �� r,_ s CL),_ Owner Mailing Address: -/P2. cl v As N <-1,(-)tj r-2-0 f--C:D 0.V I C�4a CA e9 t"'j 'j C I, Owner Property Address: ii c,f,-CS, Sri Name and phone number of contact person P , Egg o- i i- (^,' Ll 7 �z 2�70 Tax Map No: 1000 Section 621 Block L-1; Lot 12- Co Cross Street G r-, (A C_ f?,L V r) NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WIT.pH HEALTH DEPARTMENT APPROVAL Si attire of Applicant Date Received by: ___ !z- (cy — { oil i 9g Z� • t Ac 5 {w F OLI bb INV lilt" i _ w r. r fir Ito h 11 f l © Y2 rr ,n J 1 r r r I Pry l t l b ySO . t 1 CO _ k OC ° cc �asfi' 3° t7 A �. `Z_ ROFESSIOW �s S 002> j (_._c.G CNS � ,.q,�� - { ., '"a"� �il.� -'r- SGT cNE`.T � ��etry C)F- p12GPC7S=�J Cc.4�Cl`- SvS...CECy� v�+ tN 7 Elti t k CI GY, Q_ W A it� CiV t1_t1� � 1�rcC T iZI C S r J La� �iN c � Robert Bwatt PE, 429AMS"tOn P,00d, CUtdl0 :!' , HY 1!935, el 631 875 0275 FO be r1i b=err L,Itgoptorline_nei i These r1? S cre all IP.Su t1 , c e s `i e t �)fO;aerij, o If ?7�CL Gi l• C1iL, al ci i