HomeMy WebLinkAboutPurita ELIZABETH A.NEVILLE }' Town Hall, 53095 Main Road
TOWN CLERK P.O.Box 1179
Southold,New York 11971-
REGISTRAR
1971REGISTRAR OF VITAL STATISTICS Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER ' southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 or Non-Residential @$25 X Application No.
-- -
Permit No.
i
Applicant NameNancy Steelman
Applicant Mailing Address 25235 Main Road,, Cutchogue,�NY
Septic Tank X�h�esspool X
Brief Description of Proposed Construction or Altcrat.oll_-Bujld-2- ew,-SC l(JS,approved,,systems r
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Location of Proposed Construction/Alteration:
Claudia Purita
Owner of Property:_
Owner Mailing Address:„_.__1 ��5_S.� ►r�Vi_ AveCl.u-,�So�thold_TNY j 971...�____-.___
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Owner Property Address: 5195 Old North Road, Southold, NY 11971
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Name and hone number of contact arson M�Ngncy Steelman 631 734_-64�
p p 05 _.�.
Tax Map No: 1000 Section._._._._� 51..__..._Block _ _ .., Lot 4.17... j
Cross Street _—�y.... ead_ _ �aw ,� �. __ _�,_. ..-,-.,.-
NOTE: LOCATION MAP MUST BE S BMITT WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURA° - ITH E TH D PARTMENT APPROVAL
Si aturc opplicant Date I
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Received by:
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Suffolk County Department of Health Services
Approval for Construction a Other Than Singe ramjifff
Reference I�Jo. � � Design Flow
Use(s) ]7L
These plans have be n reviewed for ge al conforman
County Department of Health Services standards,relating to and sewage disposal. Regardless of any omissions,inconsiste
of detail,construction is required to be in accordance with the attached TE F NFtV
Permit conditions and applicable st dards unless specifically waived by ���G�
the .Department. This approval qxpikes 3 years from the approval date,
gAva
tor renewed.
Da tc Reviewer
A'
P MEC
0701
DRAWN BY:
A TION INSPECTION REQUIRED UT
FOR S ITARY TESTI A CHECKED BY:
NS
DATE:
July 24 2015
SCALE:
1 Q. = 20"-0'
SHEET TITLE:
SITE
UTILITIES
PLAN
SHEET NO.:
N$ftsu
Line(s) Be Inspected y T` e �0� a � ��
Countyt. Of Health Service .
fours In Advance,
U F.CCS HEALTH�lnspection(s). OF CE OF ViA TEVVA,'t'j' 6c
SCDHS SUBMISSION
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F
COVERED
\ NO KATER. ENTRY
\ NO SANITARY Rr=LG?C ATED
AALL
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ON ASPHALT,
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SURFACIN(S \
ON ASPHALT �} M.6