HomeMy WebLinkAboutBrodsky ELIZABETH A. NEVILLE,MMCTown Hall, 53095 Main Road
TOWN CLERK 'S P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631)765-6145
MARRIAGE OFFICER " "JS!
Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER � www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICERw
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Southold Town Clerk's Office
DATED: November 1, 2018
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4675 for a Cesspool/Septic Tank Construction
Permit submitted by:
Jim Brodsky
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:.
Signature
....._..........
Dated .�.
FF
ELIZABETH A. NEVILLE C= Town Hall, 53095 Main Road
TOWN CLERK cm P.O. Box 1179
REGISTRAR OF VITAL STATISTICSsr" «� Southold, New York 11971
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �- Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 ,/ or Non-Residential @ $25 Application No. q&7-5
Permit No.
Owner Name _, �� ova'
Owner Mailing Addres �jm ,. " � _
t�
Owner Property Address �gj
Owner Telephone No.
Tax MapNo: � Section _ IT_ Block Lot.-,.......
6
Cross Street 0m% 'Q .,'au.
Please check each that applies: New Construction
Alteration to existing System
Residential Non-Residential
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 s init copy of survey with SCHD approval.)
_ Le-2 i0 W
Sig Ita -of Applicant Date
Q
Received by: •J.
Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 11/01/18 Receipt#: 249419
Quantity Transactions Reference Subtotal
1 Septic Permit-Construct- Resid. 4675 $10.00
Total Paid: $10.00
Notes:
Payment Type Amount Paid By
CASH $10.00 Brodsky, Jim
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name.: Brodsky, Jim
255 Founders Path
Southold, NY 11971
Clerk ID: JENNIFER Internal ID:4675
S.C.T.M. NO. DISTRICT: 1000 SECTION: 97 BLOCK: 3 LOT(S): 13.1
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r1lFINAL SURVEY 08-21 -18
M cADD SEPTIC LOC. 01 -16-18
AREA: 1 ,632.88 S.F. OR 0.40 ACRES ELEVA77ON DATUM: aNAVD88
RIZED AL7ERAT70N OR ADD177ON TO THIS SURVEY IS A WOLA77ON OF SECT70N 7209 OF THE NEW YORK STA 7E EDUCATION LAW. COPIES OF THIS SURVEY
MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY, GUARANTEES INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE 777LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION
LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE.
THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECT70N OF FENCES, ADD177ONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS
AND/OR SUBSURFACE S77?UMRES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY
SURVEY OF: DESCRIBED PROPERTY CERTIFIED TO: JAMES M. BRODSKY;
MAP OF: FIDELITY NATIONAL TITLE INSURANCE COMPANY;
FILED:
SITUATED AT: CUTHOGUE
TOWN OF: SOUTHOLD KENNETH M WOYCRUK IJ. D SURVEYING, PLLC
SUFFOLK COUNTY, NEW YORK Of Professional Land Surveying and Design
P.O. Box 153 Aquebogue, New York 1)4931
FILE # 1 F 153 SCALE: 1 »=30' DATE: SEPT. 8, 201 6PHONE (631)298-1588 FAX (631) 298-1588
N.YS. Ll' NO. 050882 maintaining the records of Robert J. Hennessy k Kenn Woychuk
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