HomeMy WebLinkAboutJohnnides ELIZABETH A. NEVILLE, MMC y Town Hall,53095 Main Road
TOWN CLERK f P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �r„ Fax(631)765-6145
MARRIAGE OFFICER Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER ” JG' www.southoldtownny.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: December 18, 2018
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4687 for a Cesspool/Septic Tank Construction
Permit submitted by:
Robert Wilson for Fran & George Johnnides
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 _Well
Comments:
Signature
�w...... �..............................
Dated
ELIZABETH A. NEVILLE Town Hall, 53095 Main Road
TOWN CLERK �� P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
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
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10.......... or Non-Residential @ $25 ApplicationNo3- U 003
Permit No.
Applicant Name u vo
.1
Applicant Mailing Address h V 11 cK
( ..
Septic......... .....�. m
Tank r/ or Cesspool
Brief Description of Proposed Construction or Alteration—
r-
lterat:ion____r... .. W, ..tN ......_..
Location of Proposed Construction/Alteration:
Owner of Property: x(vr Tc/h y 1; 111 .........
Owner Mailing Address: � ... �
Owner Property Address: S'0Lmr._ 0
Name and phone number of contact person ww
Tax Map No: LDw Section J Block Q Lot 9_1ck
Cross Street s
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY W "!H EALTH DEPARTMENT APPROVAL
Signature of Applicant Date
Received by: ��
Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 12/17/18 Receipt#: 250238
1
Quantic Transactions ReferenceSubtotal Septic Permit-Construct- Resid. 4687 $%00
Total Paid: $10.00
Notes:
Payment Type Amount Paid By
Credit Card-Ref# $10.00 Wilson, Robert
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: Wilson, Robert
Po Box 49
Southold, NY 11971
Clerk ID: JENNIFER Internal ID:4687
SCDHS REF No. R 10-18—0037
N CAPTAIN SURVEY OF PROPERTY
KIDD ROAD A T MA TTITUCK
TOWN OF SOUTHOLD
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TEST HOLE DATA ,
WDONALO GEOSCIENCE
09/18/2017
EL.74.7' - DARK BROWN LOAM OL D
----- 0.5' R O A
BROWN CLAYEY SAND SC RVQ'
PROP05ED SEPTIC 5Y5TEM
--- 16' 5 DEDROOM HOUSE
PALE BROWN nNE SAND SP 1"PREGA5T 1500 GALLON CYLINDRICAL SEPT I G TANK
1-LEAGHING POOL5 8'� X 15' DEEP
23, WITH 3' SAND GOLLAK 3' MIN. A60VE
GROUND WATER
NOTE:• NO WATER ENCOUNTERED
RAIN RUNOFF GONT61NMENT
HOU5E + GARAGE . 1557 5Q. FT.
MONUMENT 1557 X 1 X 0.17 265 GU.FT, NES
265/42.2 6.3 VF
Lo
AREA=10,230 sq.ft. PROVIDE (1) DRY WELLS 8'� X 7' DEEP
OR EQUAL CONNEGT TO HOUSE WITH N
LOT NUME5EK5 REFER TO "MAP OF CAPTAIN KID[) E5TATE5" GUTTEK5 + LEADERS _
FILED IN THE SUFFOLK COUNTY CLERK'5 OFFICE _
ON JAN. 19, 1949 A5 FILE NO. 1672 _
ANY ALTERATION OR ADDITION TO TH 15 SURVEY 15 A VIOLATION S. LIC. NO. 4961
OF 5EGT I ON 7209OF THE NEW YORK STATE EDUCATION LAW, RS, P.C.
EXCEPT A5 PER 5EGTION 7209-5U60IV15ION 2. ALL GERTIFIGATION5 (6 0 FAX (631) 765-1797
HEREON ARE VALID FOR TH15 MAP AND GOPIE5 THEREOF ONLY IF P.O. BOX 909
SAID MAP OR GOPIE5 E5EAR THE IMPRF-55ED SEAL OF THE 5URVEYOR 1230 TRAVELER STREET
SOUTHO D, N. Y 11971 1 —099