HomeMy WebLinkAboutHintze ELIZABETH A. NEVILLE, MMC ��;��u � �° Y Town Hall, 53095 Main Road
TOWN CLERK � °� ' , P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS r situ " Fax(631)765-6145
MARRIAGE OFFICER '�J� � t Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER I 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: September 3, 2019
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4777 for a Cesspool/Septic Tank Construction
Permit submitted by:
AMP Architecture for HenryHintze
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
f F04'
Town Hall,53095 M a
ELIZABETH A.NEVII.LE � � �'�� P.O.Box 1179
TOWN CLERK "� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 !
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
DISTRICTSOUTHOLD WASTEWATER
A YLICATI N
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL r SEPTIC TANK
Residential 10 or Non-Residential @$25 Applic 'o o.
Permit No.
Applicant l acne AMP Architecture
Applicant Mailing Address._ 1075 Franklinville Road Laurel N.Y.
Septice p1
Brief cri toin of Proposed
Construction'on or A1tcration,-_Rq_M_O rLtir
system;
Renlacin with new lad OWT
Location of Proposedons ctio t ti :
Owner of rope :--He "b
Owner Mailing Address*� 500 Sipes Neck Road, Greenp2q
Owner Property .,d rw, ...®_ Pipesra ga port
AMPAhone o f contact person
r i r516-214-0160
Name
Tax Map o: 1000 Section _ lock 1 Lot _ 1
Cross Street i ( )
CONSTRUCTIONNOTE: LOCATION MAP MUST E SUBMITTED WITH APPLICATION. NEW
S U Y WITH HEALTH DEPARTMENT APPROVAL
Si tre ppti aot Date
eceived by:
SAF I - E PA R_MEW OF HEAL TH S EI
`1 FOR APPWVAL 07 COXl3CnON POR A it
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