HomeMy WebLinkAbout1505 Birdseye Road LLC ELIZABETH A.NEVILLE,MMC Town Hall,53095 Main Road
TOWN CLERK ' P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS - Fax(631)765-6145
MARRIAGE OFFICER a Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER # 1 www.southoldtownnygov
FREEDOM OF INFORMATION OFFICER _ a»T
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born,Southold Town Clerk's Office
DATED: October 7,2019
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No._4795 for a Cesspool/Septic Tank
Construction Permit submitted by:
Michael Kimack for 1505 Birdwye Road LLC
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
co
REGISTRAR OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICER Fax(631)765-6145
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 or Non-Residential @$25 Application No.
Permit No.
Applicant Name fCEr 4E A. dstt
Applicant Mailing Address -
3 OX 10 4r 7 -001-- V 77
Septic Tank--or Cesspool
Brief pescription of Proposed Construction orAlteration
_YTIZAI—i--OW -57 A59,,-0 0 ZI a C&O-El-9A-16,-
Location of Proposed Construction/Alteration:
Owner of Property: 0 -
Owner Mailing Address: / 1r
x/5 N-Y /0
Owner Property Address;X4 AeDAD 0eZZW7-
Name and phone number of contact personCAXZG.5 �4TA ZAP 7 4th-8 9-5e
Tax Map No: /0970 Section 17 Block Lot 0-0-
Cross Street 7 4-5-$A4T Al a,": R 7.7
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
049
Signature of Applicant Date
Received by: lvv tot-11
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1505 EIRDSEYE ROAD LLC Legend
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