HomeMy WebLinkAboutCimino Town Hall, 53095 Main Road
ELIZABETH A.NEVILLE,MMC
TOWN CLERK ` p� PrP P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �d� rG� Fax(631)765-6145
MARRIAGE OFFICER Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER �� ��" wwYg
w.southoldtownn . ov
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 11, 2019
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4782 for a Cesspool/Septic Tank Construction
Permit submitted by:
Michael A. Ki.mack for Cono Canino
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
m..
Dated
ELIZABETH A.NEVII..LE �" ""
Town Hall, 53095 Main Road
TOWN CLERK - ' P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS tri
�. Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER " * Telephone(631) 765-1800 l
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPL]KATIOT
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
or Non-Residential $25 Application No.
Permit ?,4b_
Residential @$10 � @
Applicant Name
pP
Applicant Mailing Addre.
SIe tic Tank*X/ or Cesspool
p or Alteration 1' `
Brief Description of Proposed Contructio
A
Location of Proposed Construction/Alteration:
Owner of Property: COA.IP
Owner Mailing Address: a - X1797
Owner Property Add c s _: -
Name and phone number of contact person
Tax Map No:/Ua0 Section. -Block.-- Z t
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
. . .........�4ezo,/�
Signature p
of Applicant Date
Received by: _.
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