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Home My WebLink AboutCouden g�FFOt,� ELIZABETH A.NEVILLE,MMC ��0� C0 Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Cie Fax(631)765-6145 MARRIAGE OFFICER ,j. ��. Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER �O,( •�`1 www.southoldt6wnny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK [�QMVE TOWN OF SOUTHOLD D DD 'O: Southold Town Building Department JUL Z 7 2017 ROM: Sabrina Born, Southold Town Clerk's Office BUILDING DEPT. TOWN OF SOuTHOLD )ATED: July 27, 2017 "ransmitted herewith is a copy of application No. 4502 for a Cesspool/Septic Tank ALTERATION ermit submitted by: Kathleen Donnelly Couden lease review the application and location map and advise if the project has received Suffolk County lealth Department approval and if this office may issue the permit. 'lease complete the form below-and return it to me. Thank you have reviewed the application and location map of the project cited above and make the following ,,commendations: APPROVE DISAPPROVE .omments: Maintain required setbacks from adjacent wells, buildings, property lines and water Bodies. EXCAVATION INSPECTION REQUIRED. S RECEIVE® Signature AUG - s 2017o8 6-7 Southold Town Clerk 1,010014r ELIZABETH A. NEVILLE, MMC Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 CA REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD 'O: Southold Town Building Department ROM: Sabrina Born, Southold Town Clerk's Office )ATED: July 27, 2017 ransmitted herewith is a copy of application No. 4502 for a Cesspool/Septic Tank ALTERATION ermit submitted by: Kathleen Donnelly Couden lease review the application and location map and advise if the project has received Suffolk County lealth Department approval and if this office may issue the permit. lease complete the form below and return it to me. Thank you have reviewed the application and location map of the project cited above and make the following -commendations: APPROVE DISAPPROVE 'omments: Maintain required setbacks from adjacent wells, buildings, property lines and water Bodies. EXCAVATION INSPECTION REQUIRED. Signature BLIZAI3ETII A. NEVILLE ,`� ��G Town Hall, 63096 Main rtoa� TOWN CLERK - P.O. Box 1179 Southold REGISTRAR,OF VITAL STATISTICS � � New York 11971 MARRIAGE OFFICER Fax (631) 765-6146 RECORDS MANAGEMENT OFFICER ��0� �0� Telephone (631) 766-1800 FREEDOM OF INFORMATION-OFFICER �` southoldtown.northfork.net OFFICE OF THE TOWN CLERK RECEIVED TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT JUL 2 6 201 APPLICATION Southold Town Client CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 or Non-Residential @$25 Application No. Permit No. Applicant Name C 1 Applicant.Mailing Address C Septic Tank. or Cesspool Brief Description of Pr posed Construction or Alteration 1 1 C'_ e c?. YZ CI Location of Proposed Construction/Alteration: Owner of Property:_% t ��,t 41 Owner Mailing Address: -*()v Owner Property Address: A °` - (A > 5 9 Name and phone number of contact person C1 0(A ' 4 2 Tax Map No: � U C7 Section 90 Block Lot Cross Street s T \1 1 NOTE: LOCATION MUST BE SUBMITTED WITH PLICATION. NEW CONSTRUCTION +QUIRE S SURVVY WITH HEALTH DEPARTMENT APPROVAL Signature of Applicant Date Received ` .'Q - Ls- v�rEs�' - �.- A p o ic P _ ®o su V Y J=,op- NELEN f _7 1 't 7 4 t � ( �r aE9 Acf gmgai�n J6 n9�tT1 ' —$` jp(g$$t99LVEY IS A VIOtAT109d ST �OM 9209 OF T141 P6EW r0 ST jp�TIOM LAW. f gQREs OF THIS SURVEe mol SEa f .'I a%FAMD SURVEYOR'S INKED SEAL OK t wb t I © Q MMSM SEAL SHALL NOT U CO'4*0tEA 1 t� Y a VALID TRUE COPY. :_! 't' Q v) i rUALOOM I:tDICAIED MCREON SMALL WK v ZQ Q pMY TO.THE PERSON FOR WHOM THE S""" J (MJ • '` �$DREP��T' AND ON it1S BEHALF TO � � C�F7 G. ��Y} p . j ;h Q QF CpWPgNY,:OvEkNMENTAL AGEW' fj IEAiA9G IMSTIdUTION US ED MES�Ora. ^` $ f�` � e�f� t.:�•,' �} S f4 THE ASSIGNEES Of THE LENDING tt"` SUARV4M ARE HOT TILAW j L FO ADWIOMAL�¢asY t crrv� ! ti tt . s VAN 7-uYL I a N.Y.