HomeMy WebLinkAboutGallucci ELIZABETH A.NEVILLE MMC �iU�� °o°����
�� ��, Town Hall,53095 Main Road
TOWN CLERK �� P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS puo Fax(631)765-6145
MARRIAGE OFFICER pM � Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER 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 23,-2019
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4805 for a Cesspool/Septic Tank Construction
Permit submitted by:
Steve Zoumas for William Gallucci
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
Town Hall, 53095 Main Road
ELIZABETH A.NEVILLE "�"
TOWN CLERK P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631) 765-6145
MARRIAGE OFFICER Telephone (631) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER "' southoldtown.northfork.net
OFFICE OFTHE:E 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 5 s 4F_ Zoo _ ...._
Applicant Mailing Address 26 ° 2aLrre 1
Septic Tank V or Cesspool
Brief Description of Proposed Construction or Alter aion i
Location of Proposed Construction/Alteration:
Owner of Property: A�Lw _. c
Owner Mailing Address: 2 Ne
Owner Property Address:L-?2_ S �az_
Name and phone number of contact person �E fou + ►�- - v�
Tax Map No: Section 26S Block o� �m Lot oto
Cross Street_ k6e wqN .....�__
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SU V' I'I HEALTH DEPARTMENT APPROVAL
Signature of Applicant Date
Received by:
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