The URL can be used to link to this page

Home My WebLink AboutO' Sullivan f " ® � ELIZABETH A.NEVILLE,MMC ,may. Town Hall,53095 Main Road TOWN CLERK a P.O.Box 1179 hCO g Southold,New York 11971 REGISTRAR OF VITAL STATISTICS .� Fax(631)765-6145 MARRIAGE OFFICER �� aQ�' Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD i g Department Buildin De ® ECRO V TO: Southold Town p D (a FROM: Sabrina Born, Southold Town Clerk's Office AUG 2 4 2017 DATED: August 23, 2017 BUILDING DLP'P. TOWN OF SOUTHOLD RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 4512 for a Cesspool/Septic Tank Construction Permit submitted by: Kerry J. O'Sullivan 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 1 tion map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: Final qpproval required from the Suffolk County Health Department c Signature D9 2 /°7 Dated ELIZABETH A. NEVILLE,MAIC � Town Hall,53095 Main Road TOWN CLERK P.O. Box 1179 Southold,New`fork 11971 REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.;ov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CIDER TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Sabrina Born, Southold Town Clerk's Office DATED: August 23, 2017 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 4512 for a Cesspool/Septic Tank Construction Permit submitted by: Kerry J. O'Sullivan 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 reduired from the Suffolk County Ilealth Department Signature Dated � ELIZABETH A. NEVILLE Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 C4 ze Southold, New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER ��f9l � � 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. t Permit No. i� '" Applicant Name (9--a( `� Applicant Mailing Address celk Septic Tank or Cesspool j Brief Description of Proposed Construction or Alteration Location of Proposed Construction/Alteration: Owner of Property: @, 94,f/i` Owner Mailing Address: Owner Property Address: 6 � Name and phone number of contact persons t Tax Map No: Section Block Lot Cross Street L � 0 e ' NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL Al_' ! e Signature of Ap licant Date Received by: _ a 36f lisf m of �0iltUri 1Crli �tdi� T' �P Nle�0 VINCENT LUCARELLI,A.I.A. No.028296 (3-7-2013) "I HEREBY CERTIFY THAT THE WATER SUPPLY(S)AND /OR SEWAGE DISPOSAL SYSTEM(S)FOR THIS PROJECT WERE DESIGNED BY ME OR UNDER MY DIRECTION. BASED UPON A CAREFUL AND THOROUGH STUDY OF THE SOIL,SITE AND GROUNDWATER CONDITIONS,ALL LOTS,AS PROPOSED,CONFORM TO THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES CONSTRUCTION STANDARDS IN EFFECT AS OF THIS DATE." NOTE:THERE IS AN EXISTING WATER MAIN AVAILABLE TO r T, ALL SURROUNDING THE ABOVE CAPTIONED PROPERTIES ARE PROPERTY FROM TERRY COURT. IMPROVED WITHIN (SEE ATTACHED LETTER) 150' OF ALL PROPERTY LINES vv�� ALL DWELLINGS ARE 4� CONNECTED TO PUBLiC WATER ® � THE AVERAGE FRONT YARD HEALTH DF-PART MNT'S APPROVAL STAMP SETBACK WITHIN A 200' RADIUS IS +/-35'-0". 100.0' SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT FOR APPROVAL OF CONSTRUCTION FOR A SINGLE- 'AMILY"RF-SIDENCE ONLY 4 A ZI ( p Lj i KS� REF. 0. 1 ( '" .. APPROVED FOR A IMUM EDR ��S � _. EXPIRES T YEARS OMXrEl Or APPROVAL�