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ELIZABETH A. NEVILLE,MMC 0 Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 0 ® 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
o
TO: Southold Town Building Department D
FROM: Sabrina Born, Southold Town Clerk's Office
FROM: 16 2018
DATED: April 12, 2018 BUILDING DEPT-
TOWN OF SO'UTHOLD
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4599 for a Cesspool/Septic Tank Construction
Permit submitted by:
Dennis McMahon for Lisa Howard.
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
O 30
Dated
rj
o�Q��FFo(�-Co
ELIZABETH A. NEVILLE �`� �� Town Hall,63096 Main Roa-
TOWN CLERIC q _ P.O.Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �y-
MARRIAGE OFFICER Fax (631) 765-6146
RECORDS MANAGEMENT OFFICER y�f�/ y y�O� 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
Residdntial @$10 or Non-Residential @$25 Application No. 53'1
Permit No.
Applicant Name �- - _ �,-
Applicant Mailing Address C?J�
v
Septic Tank- or Cesspool---LIZ-
Brief Description of Proposed Construction or Alteration !�CCJCQ
Location of Proposed Construction/Alteration:
Owner of Pzoperty:__ \-
Owner Mailing Address: qS Ll I—) a c- a su -St
�o t
Owner Property Address: S
Name and phone number of contact person 12\
Tax Map Map No: Section IS, Block ON -- Lot .
Cross Street SQ
NOTE: LOCATION MAP MUST-BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH D PTMENT APPROVAL
t ature of App icant Date
Received by:
O = MONUMENT 5ET N= MONUMENT FOUND Q= STAKE SET - STAKE FOUND 0= PIPE FOUND 0= PIPE SET
TEST HOLE
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DATE. 01/03/1-1
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SITE DATA
AREAC
12404 ACRES OR 54,031 SQ. FT. 8
VERTICAL DATUM NA.V.DATUM Ocibb) o
} • 6ROS5 FLOOR AREA
EX057016 HOME t GARAGE = 2,283 50.FT. F
De
OSE POOL HOUSE = 548 5Q.FT. o
t
400 Ostrander Avenue,Riverhead,New York 114101 SURVEY FOR 8
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Thomas Cl-AOIPCrt,FroP055k rwW Enalneer Suffolk County, New York
Douglas E,Adams, 'ofesslorial s' lneer
Robert 0.Tast,Architect BUILDING PERMIT SURVEY g
County Tax Map District 1000 Section 15 Block OI Lot 9.2 31Z
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doe PLOT DATE Jon 15. 2018 - 1:03pm DWG FILE: R:\2016\2016_0185\dwg\2016-0185-bp.dwg