HomeMy WebLinkAboutGCG Bayberry, LLC ELIZABETH A. NEVILLE, MMC � 'o `'' ���a Town Hall,53095 Main Road
TOWN CLERKS P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631)765-6145
MARRIAGE OFFICER
1! Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER °
�n " � �� ����� 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:. October 10, 2019
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4796 for a Cesspool/Septic Tank Construction
Permit submitted by:
Charles Thomas for GCG Bayberry 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
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.111(o
Permit No.
Applicant Name d
Applicant Mailing Address 0 F0 _W... T
Septic Tari or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: X � � ��� � � �� �
Owner Mailing Address: ITIT i
.... L1—
Owner Property Address:
............... ......�� .. ..
Name and phone number of contact person
Tax Map No: Section Block Lot
Cross Street_... . A)10 �^tc _..._ �t S -.
TE: LOCATION UST BE SUBMITTED WITHAPPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY NVW11 DEPARTMENT APPROVAL
o
Signature of Aliplicant Date
Received by: .
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