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
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