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ELIZABETH A. NEVILLE,MMC ,10 CQ Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS to Fax(631)765-6145
MARRIAGE OFFICER ,y 0�. Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER ��! �`� www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department De D [E0
C0 %
DD
FROM: Sabrina Born, Southold Town Clerk's Office MAR 2 9 2018
DATED: March 29, 2018 13=4ING DEP'T.
TOWN OF SOUTHOLD
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4593 for a Cesspool/Septic,Tank Construction
Permit submitted by:
Bryan Nicholson for Monay Bell
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 required from the Suffolk County Health Department
Signature
Dated
Fit ,
ELIZABETH A.NEVILLE "� Town Hall, 53095 Main Road
r P.O. Box 1179
TOWN CLERK Southold, New York 11971
REGISTRAR 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
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 'V or Non-Residential @$25 Application No. 0
Permit No.
pp ?� .
A licant Name
Applicant Mailing Address ..... i ......_ t° p
Brief Description of Proposed Co___,... � �.�
Septic Tank D'�or Cesspool
p p Construction or Alteratio ,�,w°�
Location of Proposed Construction/Alteration;
Owner of Property:��
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Owner Mailing Address: mm.T /f Iry _.���_.- ....... ._......_ .
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Owner Property A.dlrs: o- ..a � ,�., a ;� � ...._��` � ._
Name and phone number of contact person - O? I °
Tax Map No: lVb Section .w Block _....._____ o ' �... .........
Cross Street ... B Vpm�� �.. 1 ......_ U...� ._. . ......� .......... ...�__.— ...�� _ .....�.e.
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
i g 1 a tIlrl of A licant Da
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Received by: .... ..... - ..
RAIN N. I. 0F CO .1r E I....., RO O5 ;V 2EF I G «r 9 TEM
S PROPERTY 4 DE�ROOM HOUSE
HOUSE - 977 5Q. FT u
a tGREENPOR T 977 X I X 0.17 166 GU. FT. I-PKEGA5T 1000 GALLON SEPT I G TANK
rT DRIVEWAY = 666 5Q. FT 2-8 LEACHING POOL5 6' DEEP
TOWN OF V
666 X 0.8 X 0.17 = 91 GU. FT. WITH 3' SAND DOLLAR 3' MIN. ABOVE
_ S COUNTY � Y. - 256 GU. FT. GROUND WATER i w
1000-48—Oi�.-2e3 256/22.3 - 11.5 V.F.
�r PROVIDE (2) DRYWELL5 64 X 12' TOTAL DEPTH
mm SCALE: 1'--30'
OR EQUAL
w W JUNE 29, 2017 DRYWELL5 GONNEGTED TO HOU5E WITH LEADER5 666.5 5Q.FT.
JUL Y 10, 2017 (PROPOSED" HOUSE)
LVD
a JULY 26, 2017 (CER 17nCA 110NS)
AUGUST 4, 2017 (REVISIONS)
LOT 78
LOT(g
._.,� � i 82
VAGANT I DWELLING LOT O I LUT 84
I O LUT
IG WA TER I I I
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IG WATER i Du I
PLIG WATER
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EX 15T I NCS LOT AREA- 5624 5Q.FT. I
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PROPOSED NEW HOU5E- 977 5Q.FTI 100Q>So!_ _ 1
LO 72 ,
(WITH ENTRY PORCH) 1 T , I - ►_
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