HomeMy WebLinkAboutSmith ELIZABETH A. NEVILLE,MMC oe 1"�° " , Town Hall,53095 Main Road
TOWN CLERK ILII P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS � ,� °' 1 Fax(631)765-6145
MARRIAGE OFFICER °,f (hone Tele 631)765-1800
RECORDS MANAGEMENT OFFICER „� p� Telephone
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 31, 2019
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4771 for a Cesspool/Septic Tank Construction
Permit submitted by:
Meryl Kramer for Anne & Ron Smith
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
M ° 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 X or Non-Residential @ $25 Application No. L 7 l
Permit No.
Applicant Named µ
Applicant Mailing Address
.ITIT...� .. .. : ..
Septic
cnoCesspool
Description of Proposed Construction � �
Location of Proposed Construction/Alteration:
Owner of Property: ..
r � ...... '_ m
Owner Mailing Address-.
Owner Property Address:,,,,,_...
Name and phone number of contact person_
. .
Tax Map No: �0 a30action � `�.° ..m Block Lot
Cross Street '0
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SILIII 'EY WITHI j .' I'll DEPARTMENT APPROVAL
Signature f .pplicatit Date
Received by: _..
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