HomeMy WebLinkAboutElliott ELIZABETH A. NEVILLE,MMCF "w Town Hall,53095 Main Road
TOWN CLERK a anti P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631)765-6145
MARRIAGE OFFICER
�' ° �� Telephone(631)765-1800
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RECORDS MANAGEMENT OFFICER www.southoldtovnmy.gov
FREEDOM OF INFORMATION OFFICER � ��,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Southold Town Clerk's Office
DATED: October 5, 2018
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4662 for a Cesspool/Septic Tank Construction
Permit submitted by:
Fred Weber for John & Amy Elliot
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:.
................._... . ..... ................................. .. ................................__ ......_................................._..........._. .._.....
Sign .._.......
ature
........ ......____.... _.......................
Dated ...
ELIZABETH A.NEVILLE Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS 0-0 Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER ,y�w� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER Gsoutholdtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10—X or Non-Residential @ $25 Application No. "I V(ez
Permit No. ILIO - 1?5 - 60(v,3
Applicant Name ` ...._..._
Applicant Mailing Address w ..
Septic Tank >,lZr Cesspools`
Brief Dcscai tao� ion
✓ . . �� of Proposed Construction or�Alta�ra�
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...._
Location of Proposed Construction/Alteration:
Owner of Property:-
Owner Mailing Address: .... t �� �� �..._
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Owner Property Address:
Name and phone number of contact person
Tax Map No: Section
Block.... _....... Lot _ .:..........
Cross Street ..... _...._ _ _.......
NOTE: LOCATION MAP NWST, BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES S1 I HEALTH DEPARTMENT APPROVAL
ITIT
S gn turc of Applicant Dat
Received by.
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4'0 APPROVED 4,78"7r 417.9
EL +18 L' �TO GRADE EL+18' r D � X SURVEY INFORMATION:
5 9 NATHAN CORWIN, LAND SURVEYOR
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at HOUSE EL +11'-0' �LIC411D -------------
LAST UPDATED: MAY 21, 2018
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POE
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NEW 1150 GAL. SEPTIC TANK 8' O" 8" O" FIF — T
(2) POOL5.S' 4 x 8' DEEP T EXPEC 0 PAGNI`' 0 S I 3O O°
MEET ALL S.C. DEPT. OF HEALTH SERVICES REGULATIONS. HIGHES —-- 4
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