HomeMy WebLinkAboutBehrmann ELIZABETH A. NEVILLE,MMCF Ih Town Hall,53095 Main Road
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TOWN CLERK �„w� P.O.Box 1179
Southold,,New York 11971
REGISTRAR OF VITAL STATISTICS �w i� Fax(631)765-6145
MARRIAGE OFFICER Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER1 www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER ° x
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Southold Town Clerk's Office
DATED: June 18, 2019
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4762 for a Cesspool/Septic Tank Construction
Permit submitted by:
Robert & Marilyn Behrmann
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
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REGISTRAR OF VITAL STATISTICS a Southold,New York 11971
MARRIAGE OFFICER Fax 765-6145
RECORDS MANAGEMENT OFFICER ' Telephonnee((631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential@$10 ✓ or Non-Residential @$25 Application No.
Permit No.
OwnerNameauRobert $ Marilyn Behrmann
159-02 28th Avenue, Flushing NY 11358
Owner Mailing Address.... �..�.�
1700 C.....�w�. .._
Owner Property Addrs ,�...._._ Cedar Drive, Southold, NY 11971
Owner Telephone No.
Tax Map No: Section 78 Block 8 Lot..—....l 7.1
Cross Street wwKirwin Blvd. _......_ _.. .......µ.
Please check each that applies: New Construction V/Alteration to Existing System
Residential ✓ Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submit copy of survey with SCHD approval.)
Date
Received b
i
,I
SCDHS REF.# RIO-14-0018 SURVEY OF PROPERTY
N AT BAYVIEW
urz TOWN OF SOUTHOLD
SUFFOLK COUNTY, N Y.
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souTMOLD,N.Y.11971 —175