HomeMy WebLinkAboutHolman ELIZABETH A. NEVILLE,MMC J� Town Hall,53095 Main Road
�N P.O.Box 1179
TOWN CLERK ' Southold,New York 11971
r-
REGISTRAR OF VITAL STATISTICS qW, Fax(631)765-6145
MARRIAGE OFFICER � � �� „ Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER ���" �� � www.southoldtownny.gov
sz
FREEDOM OF INFORMATION OFFICER "
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: April 1, 2019
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4744 for a Cesspool/Septic Tank
Construction Permit submitted by:
John Motta for E. Gruber/J Holman
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 Hall, 53095 Main Road
ELIZABETH A. NEVILLE
TOWN CLERK P.O. Box 1179
C4 ZL* ^ Southold, New York 1197.1
REGISTRAR OF VITA[.STATISTICS � ��� Fax (631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT`OFFICER ^ Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ""� ' '° southoldtown.nortlifork.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.
qAq
Permit No.
Applicant Name......, ... a ....m ...�. . .,
Applicant Mailing Address. .....�._��a 4vftl
.���...._.'� ...�...�.,. .... ..n _ .._w... _�......�
-.�
Septic fro] _�or Cc
ss
oo1
Brief Description of Proposed Construction or Alteration
...44
__ .
Location of Proposed Cotistruction/Alterat on:
Owner of Property: Pew- _..�e�.. r . . .,_ 1ern�e _ olm" .... m�.. ..._._......... — ...
Owner Mailing Address: a
Owner Property Address: m .. �@n..�. gocd�...._�CL_)_�k_......!r Ve N y...1.-!.9?5
Name and phone number of contact person .. 777/. �_//0
Tax Map No: Section -4,0e&......
��. ...... Block __ m , _ Lot �,.- —
Cross Street �'. �� _. Vii. ...r... _ 7777_.. el d .. .. . ....... . .....ti.. .................m�_ �...._ _,.
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY ,VITH HEALTH DEPARTMENT APPROVAL
Sigel re of l lw lnt DG .e
Received by:
SITE DATA WAR,
V%
LOC TION MAP
<- Z
co
,t r
(n
2z
In—,0
QVI
7
4_1
CQ
AM
SUE-LAN
�00 clallo) -A.=-14
WOW
SITE PLAN sp
r4 BUILDING PERMIT SET g