HomeMy WebLinkAboutWeiss ELIZABETH A. NEVILLE, MMC 6p Town Hall,53095 Main Road
TOWN CLERK r„. P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICSi 11 Fax(631)765-6145
MARRIAGE OFFICER � �' Telephone(631)765-1800
RECORDS MANAGEMENT OFFICERS 1 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: January 22, 2019
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4694 for a Cesspool/Septic Tank Construction
Permit submitted by:
Daniel Weiss
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
Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 01/22/19 Receipt#: 251098
Quantity Transactions Reference Subtotal
P 4694 $10.00
1 Septic Permit- Construct Resid,
Total Paid: $10.00
Notes,.
Payment Type Amount Paid By
CK#2465 $10.00 Weiss, Daniel
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name:. Weiss, Daniel
271 Andrew Ave
East Meadow, NY 11554
Clerk ID: JENNIFER Internal ID:4694
ea
Town Hall, 53095 Main Road
ELI, E'TH A.NEVILLE
TOWN CLAS ^� P.O.Box 1179
+ Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
GE OFFICER Fax(631)765-6145
MARRIARECORDS 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 Q$10 or Non-Residential Qa $25 Application No.
Permit No. yrITt
Applicant Name.,,,,, w
C ,ST SSV
Applicant Mailing Addrefss..
lie
Septic Tank or Cesspool
Brief Description of Proposed Coi.istruction or ,lteniti ll ag
41
Location of Proposed Construction/Alteration:
',111
Owner of property r °a
Owner MailingAddress:,_ _.
Owner Property Address: IV-V, r.
Name and phone number of contact person _ ..........
Tax Map No: Section
S Block __.. . Lot 7
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURyEY W H FtklTffDEPARTMENT APPROVAL
�1 'vml�j
Signature of Applicant Date
Received by. ,
�rNJ is f d r# /o 0� `m s dGlc O /vovsc
l U 3.4 /hZ
i1
SURVEY OF
Q10�-�� Boa 2 ,1
P/0 LOTS I 0 8&110
.9 � O T 109
r1 Q a / `r Il Il
. E AMENDED MAP A
OS PECONIC BAY ESTATES
N �p� o cod° FILED MAY 12, 1933 FILE NO. 1124
A ,Ifs , + �_ , AT ARSHAMOMAOUE
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
1000 -Z& - 04 - 27
�0 (' d 30'
Sept. 25, 1987
G0
O
. .vJ 2
3 4 / � \\0 S a5 A - CERTIFIED TO
'0 ` 0
Of
FIRST AMERICAN TITLE INSURANCE CO. OF NEW YORK
w� a 10 �' LINCOLN SAVINGS BANK
P JOHN MARCHETTI
n ` MARIE MARCHETTI
0 110 .ANO
r' LIC. NO. 49668
V I n,purod in accordonm who, O ENGINEERS, P.C.
I..a ,111.1 if„J•11 '
standards far t le AIMYJ as estoblLhoo at P.O.
Ohe I..i,A.LS..W approved and iidoplod MAS'
G for such use by �t4a York State fund SOUTHO r 1971
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