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HomeMy WebLinkAboutLindsay ELIZABETH A. NEVILLE,MMC � �� °° ��, , Town Hall,53095 Main Road TOWN CLERK `x P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER m Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER rUl � 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: March 8, 2019 RE: Cesspool Construction/Alteration Application Transmitted herewith is a copy of application No. 4704 for a Cesspool/Septic Tank Construction Permit submitted by: William A. Lindsay Jr. 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 ELIZABETH A.NEVILLE "" Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 Southold, New York 11971 REGISTRAR,OF VITAL STATISTICS Fax(631) 765-6145 MARRIAGE OFFICER 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 Application No. Permit No. Applicant Name ® � �r�J�f� _�:.. Applicant Mailing Address pp g .-.... _ ,-or Cess Construction Se tic Tank pool � . Brief Description of Proposed Con P `� p ion or Alte��at:%oi�r �' )�� • / Location of Proposed Construction/Alteration: Owner of Pr(,)perty:_. _ r L-,�1�(�._!.. ►— Owner Mailing Address: /, Owner Property Address: Name and phone number of contact person ... �" _ Tax Map No: Section r/ Block 7 — 7- , -5/ Lot Cross Street `. ... ,a NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SUAVE "WITH HEALTH DEPARTMENT APPROVAL Signature of Applicant Date Received by: _ Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 03/08/19 Receipt#: 251979 Quantity Transactions Reference Subtotal 1 Septic Permit-Construct- Resido _ 4704 $10.00 Total Paid: $10.00 Notes: Payment Type Amount Paid By CK#6046 $10.00 Lindsay Jr., William A. Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Lindsay Jr., William A. 2695 Cox Neck Lane Mattituck, NY 11952 Clerk ID: JENNIFER Internal ID:4704 .��y s �• ° :�, � _. .` �' .� �. -�. �' �- � ,. � � i �� �� �� R. � � Z �� ., ,� .�..