HomeMy WebLinkAboutWeiland ELIZABETH A.NEVILLE,MMC �� � � '�
Town Hall, 53095 Main Road
TOWN CLERK � y P.O.Box 1179
i Southold New York 11971
REGISTRAR OF VITAL STATISTICS ����� Fax(631)765-6145
MARRIAGE OFFICER Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER „ '" www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICERr
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Southold Town Clerk's Office
DATED: March 8, 2021
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4946 for a Cesspool/Septic Tank Construction
Permit submitted by:
Barbara Schnitzler
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 X or Non-Residential @$25 Application No. 1 v`
Permit No.
Applicant Name
Applicant Mailing Address
Septic Tank-or Cesspool
Brief Description of Proposed C nstruction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property:. � I A —&) "i
Owner Mailing Address:
y+ 6
Owner Property Address:
Name and phone number of contact person_., 3 7
Block Lot
7
Tax Map No: Section—AL— j��,
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
mature of Applicant Date
Received by: ,_,_ ,
Town of Southold
P.0 Box 1179
Southold, NY 11971
ti
d
* * * RECEIPT * * *
Date: 03/08/21 Receipt#: 278356
Quantity Transactions Reference Subtotal
1 Septic Permit-Construct- Resid. 4946 $10.00
Total Paid: $10.00
Notes: 111.-13-11 (Weiland,Jane)
l;
J
� Amount Paid By
Payment Type
CK#1400 $10.00 Schnitzler, Barbara
{i
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: Schnitzler, Barbara
Old Harbor Road
Po Box 229
New Suffolk, NY 11956
Internal ID:4946
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Clerk JENNIFER
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