HomeMy WebLinkAboutPeconic Land Trust g�FfOl�
ELIZABETH A.NEVILLE,MMC 0� C0 Town Hall,53095 Main Road
TOWN CLERK = P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS t Fax(631)765-6145
MARRIAGE OFFICER Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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TO: Southold Town Building Department
2 D
JUL 2 2018
FROM: Sabrina Born, Southold Town Clerk's Office
BUILDNG DEPT.
DATED: June 28, 2018 TOWN OFSOUTHOLD
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4623 for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Land Trust, Inc.
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
i
Signature
07/.it,coo
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Dated
�oSVFFO�,�►C'
ELIZABETH A.NEVILLE `Z`� ®� Town Hall, 53095 Main Road
TOWN CLERK p y� P.O. Box 1179
CA = Southold, New York 11971
REGISTRAR OF VITAL STATISTICS hT
MARRIAGE OFFICER � • � Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ��lJ O� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER O'� �a southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10y or Non-Residential @$25 Application No. 7 �3
Permit No.
Applicant Name l -
Applicant Mailing Address 910 )-4y
PO. 13OX 1-77 119
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration ---Db-noc�
Location of Proposed Construction/Alteration:
Owner of Property:r- '"nkl(G I A�)D
Owner Mailing Address:_' b
Pa fax 1 77 (7 �� ��0
Owner Property Address: 4�L(Dc)
Name and phone number of contact person -4f-1.4-
Tax Map No: Section Block l Lot
Cross Street � i Yli�
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
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Signature of Applic Date '
Received by:
SUP YULK UU U.N 1-Y, 1V. Y.
5 1000-63-01-1.11 & 1.12
SCALE: 1'-30'
MAY 4, 2017
SEPTEMBER 5, 2017 (PROPOSED HOUSE)
\ OCTOBER 18, 2017 (REVISIONS)
\ MAY 14, 2018 (PROPOSED BUILDING)
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SUFFOLK _ E A nmENT OF HEALTI SERVICES
PERMIT FOR RO-vw OF CONSTRUCT'ON FOR
SINGLE FAMI' RE
APPROVED
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