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ELIZABETH A. NEVILLE,MMIC ���� � "k� Town Hall, 53095 Main Road
TOWN CLERK t��� ;"� P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �� "w� a` Fax(631)765-6145
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MARRIAGE OFFICERRECORDS Telephone(631)765-1800
FREEDOM OF INFORMA ION OFFICER
AGEMENT OFFICER �� �r �'ww.southoldtownny.gov
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: January 26, 2021
Transmitted herewith is a copy of application No. 4938 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Thomas J. Kelly
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and 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: Marr7ta�n �'� ���i°cd s
etbacl�s frc la a erwt wells, b u.� dingsm l ro.pert l.i es and water
Bodies. EXCAVATION INSPECTION REQUIRED,
Signature
Dated
From: Thomas Kelly thomaskll@aol.com
Date: Jan 20, 2021 at 2:16:43
To: ThomasKLL@aol.com
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