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ELIZABETH A.NEVII.LE O� G�� Town Hall, 53095 Main Road
TOWN CLERK w P.O.Box 1179
REGISTRAR OF VITAL STATISTICS O Southold,New York 11971
MARRIAGE OFFICER ® �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �ol `�►aO Telephone(631) 765-1800
FREEDOM-OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION I
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential'@$10_K-,:or, "Non-Residential @$25 Application No.
- - ? `Permit No.
Owner Name YJ . ry4e,(d~' '• I�,k ,._ ,� w `1 t . .
Owner Mailing Address_ 3 57,-d"r.)
ROnan, P, Qq l/'7 819 -
Owner Property Address
_Eas hogs nn QC-1 1193
Owner Telephone No.
Tax Map No: 1600 Section .3 _Block
Cross Street'__&ckW q i r�
Please check each that applies: New Construction
Alteration to Existing System
Residential X Non=Resi ential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system-, give north arrow and approximate distance in feet from system to building
and closest road. New,construction may submit copy of survey with SCHD approval.) wser
Si afore of Applicant Date
Received by:
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ELIZABETH A.NEVILLE,MMC �� r/y Town Hall,53095 Main Road
TOWN CLERKC RO Box 1179
y 2 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS p .F Fax(631)765-6145
MARRIAGE OFFICEROl �a0`' Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER J www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLE `-D
TOWN OF SOUTHOLD
TO: Southold Town Building Department
NOV - 6 2014
FROM: Carol Hydell, Southold Town Clerk's Office BLDG.DEPT
TOWN Of SCI THOLD
DATED: November 7, 2014
Transmitted herewith is a copy of application No. 4280 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Latham Sand & Gravel for Paul & Maryann Cadmus
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and 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: Maintain required setbacks from adjacent wells, buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signature `
�i
Dated
i•
�s
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 4280 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED T0:
Name : JOHN HOCKER
Address 1: LATHAM SAND & GRAVEL INC
City St Zip PECONIC NY 11958
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM APPROVED AS SUBMITTED. MAINTAIN REQUIRED
SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER
BODIES.
Name Of Owner PAUL & MARYANN CADMUS
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mailing Address 1 #3 SID COURT
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City St Zip HAUPPAUGE NY 11788
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Property Address 1 7005 MAIN RD
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City St Zip EAST MARION NY 11939
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Tax Map No. section 31.00 block 1 lot 3.000
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Cross Street ROCKY POINT RD
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Building Permit Number Cross Reference:
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Issue Date: 11/18/14 Elizabeth A. Neville
-------- Southold Town Clerk
('TOWN SEAL)
November 18, 2014
John Hocker
Latham Sand & Gravel, Inc.
PO Box 608
Peconic,NY 11958
RE: 1000-31.4-3 (Paul &Maryann Cadmus)
Dear Sir/Madam:
Enclosed herewith is the Construction, Alteration or Modification Permit for a Septic
Tank/Cesspool System for which you applied.
AFTER the system is installed but prior to being used, an OPERATION PERMIT IS
REQUIRED. The operation Permit is issued by the Southold Town Clerk's Office. The fee is
Ten Dollars ($10.00) for a residential system and twenty-five dollars ($25.00) for a non-
residential system. Your check should be made payable to the "Southold Town Clerk". An
application form is enclosed. Please complete the requested information and return the
application, proper fee, and LOCATION MAP (map must indicate the location of the
cesspool(s)/septic tank(s), giving approximate distances in feet from any buildings to the pools
and distances between the pools.
Should you have any questions concerning this matter, please do not hesitate to contact this
office.
Very truly yours,
Sabrina Born
Clerk Typist
Enclosures
• _ t0
FXJZAIM A NEVIYd.E Town HoR,53M Mei-Raael
TOWN C EYiS P.O.Ba:1178
REGISTRAR OF VITAL.STATIMCS %. utb*K New York 11971
MARRIAGE OFFICER • 4 Fax(631)765.6145
RECORDS MANAGEMEM OFFICER Telephane(681)763-1800
FRFJMM OF INFORMATION OFFICM smAholdtowniiarthforknet
OF]E'YCE OF THE TOWN CTJMK
TOWN OF SOUTHOLD
SOUTROLD WASTEWATM DISMICT
'AP
TLICATION
CONSTRUCTION or ALTMATION PERMM
CESSPOOL or SEPTIC TANK
Residential @$10-4- or Nan-Residential Qc $25 Application No.48
Permit No.
Applicant Name_ 3n h rl �e�. LA-��Am1 n �- rA ✓sz J, Tn C
Appucamt Mailing Aaaress_fid%x 609
Septic Tank or Cesspool
Brief Description of Proposed 'on or Alteration f I �e + Oes s�000 IS
Location of Proposed Consbuction/Altmufion: - ^/
Owner of Property.-J�Ao + QnAr�i 4n(1
Owner Mailing Address: SIU G(-)/-4
J lv)gE
Owner Pmperty Address: m�
62,54 (rWign Inti 11232
Name and phone number of contact Penson John 1�a� r@ LA-� im SHnd1+ 6rA�lSL J 734-6'8ac�
Taos Map No: /DOO Section 3 / Block__jLot _
Crus Street 20ck
NOTE: LOCATION MAP MUST BE SUBNUTTZD WITH APPLICATION. NEW
{
CONSTRUCTION REQUIRES SURVEY APPROVAL
740�=
Si tore of Applicant Date
Received by.
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