HomeMy WebLinkAboutSimone O�fF�(�►C
ELIZABETH A. NEVILLE,MMC Off' Town Hall,53095 Main Road
TOWN CLERK a� P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
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Fax(631)765-6145
MARRIAGE OFFICER ,y O`. Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER Ol �`1 www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
D [EC[ED'v[E_ D
TO: Southold Town Building Department
FEB 202018
FROM: Sabrina Born, Southold Town Clerk's Office
BIDING DEPT.
DATED: January 22, 2018 TOWN OF SOUTHOLD
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4558 for a Cesspool/Septic Tank
Construction Permit submitted by:
Gerald Simone
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Please review the application and location map and advise if this office may issue the permit.
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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:
V s
APPROVE 5
DISAPPROVE
Comments:
Signature
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Dated i
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�G Town Hall,53095 Main Road
ELIZABETH A.NEVILLE
TOWN CLERK o ". P.O. Box'1179
C#* Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �✓ '. Fax(631) 766-6145
MARRIAGE OFFICER ®y
RECORDS MANAGEMENT OFFICER O•' Telephone(631) 766-1800
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FREEDOM OF INFORMATION OFFICER _ soutboldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
F
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
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Residential @$10'0< or Non-Residential @$25 Application No.
Permit No. . '
Applicant Name
Applicant Mailing Address GENDOT HOMRS,W
P:Q.Box 534
Septic Tank _or CesspoolX '
Brief Description of Proposed Construction or Alteration
AA41 1i
Location of Proposed Construction/Alteration:
Owner of Property::
Owner Mailing Address: / y✓ !NZ lit 5 _
5541 -fW 7'0 6 .A1 l Z -7 -7
Owner Property Address.: / ! s Al I C— rel E
Name and phone number of contact person h,2 t7Y 3 l"5 a �f'S ? 17
Tax Map No: Section —7q Block r9- Lot ! 's
Cross Street_ 1 "
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES S VEY WITH HE EPARTMENT APPROVAL
AOL 5-11a I
Signature of Apacant Date
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Received by:
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LOT AF, t 8.6.,382 SQ. FT., 1 983 acres
DAtTU14" 1988~~ N:A.V D 02S
(29.5) ELEVATION VACANT mod
PROPOSE' 1 STY. FR. DWELLING W/ 3 BEDROOMS
1 ST FLOOR AREA = 1.5,45 SO FT
GAR AREA = 542 SQ: FT.. 6xiung water main
MIUL ROAD ).
TOTAL = 2,087, SQ."Fr. (28.9)
FFL ELEV 28;0 (29.6)
PECONIC MILL LANE
GAR ELtV 26:0 — S 53.1,1'40"E V=ent— — � ;— — —
8.20
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FD 650
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6.10, VACANT Excavation Inspection Required
anitary System
NOT E. For Scl 4.0
Location of water mains By Health Department
& adjoiners water- supply
by others and are not
guardnteed
NOTE, LOCA-11'ON. OF WETLAND RIBBONS WITH OFFSETS DETERMINED 13Y THE D E 7
TEST HOLE BY McDONALD' GEOSCIENCE
DATE 12/4/2017 THE M-SEM,(bR.'W10aWW).940VN HERM FMM
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