HomeMy WebLinkAboutBowe ELIZABETH A. NEVILLE,MMC Town Hall,53095 Main Road
TOWN CLERK e, P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS � '�' Fax(631)765-6145
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MARRIAGE OFFICER , ��a � Telephone(631)765-1800
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RECORDS MANAGEMENT OFFICER � www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER e�(1"1�
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. 4743 for a Cesspool/Septic Tank
Construction Permit submitted by:
John Motta for Scott Bowe
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 -- ........m_. ........
a�
ELIZABETH A. NEVILLE ��� �� Town Hall, 53095 Main Road
TOWN CLERK d P.O. Box 1179
Southold, New York 1197.1
REGISTRAR OF VITAL,STATISTICS -6145
Fax (631) 765
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
APPI,I CATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 , or Non-Residential @ $25 Application No.
Permit No.
Applicant Name.... Jai,��m a ._ _. ,......... ." .............
Applicant Mailing Address 91
( _ il .._...._ .. .....
Septic
_._ �.�... _� .
Brief Description or Cesspool .�
of Proposed Construction or Allera1i(Ai
Location of Proposed Con struction/Alteration:
Owner of Property:...,. _ _... ..�..... ._.e. .w.. .. �...._.. .,....... _,
Owner Mailing Address:. . .. . . _ �� .
Owner Property Address: -26p,
Name and phone number of contact personµ,,_.Sc®}k -576- P1
Tax Map No: Section„ 16q Block Lot 2- 7
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION, .NEW
CONSTRUCTION REQUIRES SURVE , WITH H +ALTH DEPARTMENT APPROVAL
S� .�
Received by:
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