HomeMy WebLinkAboutRomano ELIZABETH A. NEVILLE MMC Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS «, iW �'` Fax(631)765-6145
MARRIAGE OFFICER Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER kzzzz
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: September 26, 2018
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4656 for a Cesspool/Septic Tank Construction
Permit submitted by:
Philip & Doreen Romano.
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 a))roval te�t�"reed�roM the S�i:ffoll� ��a xai�T���th l cp rtment.
Signature
Dated
ELIZABETH A. NEVILLE ; Town Hah, 53096 Main Roa.
TOWN CLERK _ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �,�...
Southold, New York 11971
MARRIAGE OFFICER Fax (631) 765-6146
RECORDS MANAGEMENT OFFICER , Telephone (631)765-1800
FREEDOM OF INFORMATION OFFICER � � southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
S O UTRO LD WASTE WATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERI4IIT
CESSPOOL or SEPTIC TANK
Resilcndal g$10 or Non-Residential @ S25 Application No
Pori-rdt No."--,) CiC�
Applicant Mailing Address
AJ
Septic Tank- Cesspool
or
....�..
li sp f De,scri ation of Pro osed Const fiction or Alteration /B 4A./dam
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:-
Owner Property Address: 1,
Name and phone number of contact person
Tax Ma No: Section
p `�`� /20 ...._,Block.w ,3 Lot
Cross Street _ i
NOTE: LOCATION MAP MUST'BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SUIT " ' I'I:I DISI" TIIEI"T APPROVAL
Signature, .m_..m_...W.�..�.. _
of Applicant Date
Received by. ..
5 U RV EY Of LOT 4
A5 5HOWN ON A CERTAIN 5UBDIV15ION MAP ENTITLED"MAP OF LAUREL COUNTRY E5TATE5"
FILED IN THE OFFICE OF THE CLERK OF 5UFFOLK COUNTY JUNE 22, 1970 A5 MAP NO. 5486
SITUATE : LAUREL
TOWN : 5OUTHOLD
SUFFOLK COUNTY, NY
SURVEYED 02-07-2018
PROPOSED 07-31 -20 18
SUFFOLK COUNTY TAX #
1000 - 128 - 3 - 5 �-�P N
CERTIFIED T0=
DOREEN ROMANO
PHILLIP ROMANO dY
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I`""I UIVANT fOUND JOHN C. E H LE RS LAND 5 U RV EYO R
20% MAXIMUM LOT COVER
CHAIN LINKM..NCT.. DATUM NAVD'88
11 ` llq'w1_FENCE ®_. _.._ ....... _... ..._.. -- -r,.»,.. ... ... NO SURFACE WATERS IN 3(
6 EAST MAIN 5TREET N.Y.5. LIC. NO. 50202 ELECTRIC OVERHEAD
Area = 20,000 Sq. Ft. RIVERHEAD, N.Y. 1 1901 OFFICE: G31 -3G9-8288
Area = 0.459 Acres Je5urvey@optonllne.net
GRAPHIC :;;.ALF I`= (y
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