HomeMy WebLinkAboutTyas ELIZABETH A. NEVILLE,MMC r"i` °�a 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 o t X Telephone(631)765-1800
RECORDS MANAGEMENT OFFICERu�
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FREEDOM OF INFORMATION OFFICER cf .
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. 4806 for a Cesspool/Septic Tank Construction
Permit submitted by:
Steve Zoumas for Matthew T ➢as
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 y Southold, New York 11971
MARRIAGE OFFICER Fax(631) 765-6145
1 5
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 r ALTERATION PERMIT
CESSPOOL r SEPTIC TANK
Residential @$10 / or Non-Residential @$25 Application No.
Permit No.
Applicant Name.. q
Applicant Mailing Address "�t e .- 11-792-
Septic
1'-] ..Septic Tank V or Cesspool
Brief Description of Proposed Construction or Alteratioti J _�
Location of Proposed Construction/Alteration:
Owner of Property: Mw7MAEu� 7-VAS
Owner Mailing Address:_
Owner Property Address:
Name and phone number of contact person :5 E
Tax Map No: Section W51 Block 2 Lot S✓.00-s_
Cross Street ol-'t> r
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES S ' T HEALTH DEPARTMENT APPROVAL
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Signature of Applicant Date
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P ITVER ELFMATDNS,BAY BE Ap3J5TED IN THE FIELD TO MEET N.L.S.
RE Mu;iCEl++sv` +2' - IELO CORD IONS OR AVOID CONFLICT wTH O'TI„�ICE AS ORDERED 24"0 HEAVY_DUTY FRAME & OPEN GRATE COVER
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AS REOU:REB _ 5. ALLOW FOUR(a)INCHES FOR FINAL ADJUSTMENT OF COASTING.
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