HomeMy WebLinkAboutLaGinestra ELIZABETH A. NEVILLE MMC U ° ' y Town Hall 53095 Main Road
TOWN CLERK P.O.Box 1179
M` Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631)765-6145
MARRIAGE OFFICER �� � Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER tl -$ 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: July 8, 2019
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4766 for a Cesspool/Septic Tank Construction
Permit submitted by:
Lisa LaGinestra
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
C4 Southold,New York 11971
REGISTRAR,OF VITAL STATISTICS d Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER "r " �� 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 r✓ or Non-Residential @$25 Application No. L(766
Permit No.
Applicant Nam �
Applicant Mailing Acdres_s... X
Septic Tank . or Cesspool
Brief D s�.� a�o of Proposed Construction or W Alteration_..
Location of Proposed ConstructioiiJAlteration:
Owner o Property:
Owner Mailing "address; _.
Owner Property .ddress ��{��° .�__.
Name and phone number of contact pers �_
�� -
Tax Map No. - Section Block_ Lot
Cross Street Com., y .
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH EP . °I'MENT APPROVAL
w
J-M r �
Signature &Appficaiit Date
Received by:
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ELEVATIONS REFERENCED TO NAVD 88
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