HomeMy WebLinkAbout15105 Oregon Rd, LLC ELIZABETH A.NEVILLE,MMC Town Hall, 53095 Main Road
TOWN CLERK kq P.O.Box 1179
NY �f 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 OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: August 30, 2021
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 5060 for a Cesspool/Septic Tank Construction
Permit submitted by:
15105 Oregon Rd 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
ppm .om the Suffolk County Health De artment
Comments; Final a royal re �,rrred fr m ....
Signature
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
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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. ✓ Old
Permit No.
f
Applicant Name- v',� UU
Applicant Mailing Address - -5
Septic Tank Y�,or Cesspool
Brief Description of Proposed Construction or Altcj'ation 5�" "x.m,_
Location of Proposed Construction/Alteration:
Owner of Property:.," ry or\
Owner MailingAddress:_. . ,
Owner Property Address:. S� n S e
Name and phone number of contact person S
Tax Map No: Section 7?) Block _ _ Lot
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION WIl'IIIEALTAPPROVAL
Sig„natrrr �of lapl:icant.,- ....... Date
Received by:
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