HomeMy WebLinkAboutMilazzo John ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
~/ /~ [-/-~ 4 OFFICE OF THE TOWN CLERK
.
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
....... Fax (6~.~ 76~-6145
Telephone (631) 765-1800
southoldtown.northfork.net
Residential ~ $10 /~' or Non-Residential ~ $25 __
Applicant Name ,x.7~,~.,~.~.~
Applicant Mailin~ Address
Application No. '~ ~-~ 7
Permit No.
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
Owner Property Address:
Name and phone number of contact person
Tax Map No: Section ~'--._~
Cross Street 2/~,,4/ //~ ,q~
Location of Proposed Construction/Alteration:
Owner of Property: \~4/
Owner Mailing Address: /37
Block ~> / Lot
NOTE:
Received by: ~ d.dt_~
LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
APPROVAL
Date
NC'E~DI~ooPf-
Reference # R10-03-32, Milazzo
SPECIAL CONDITIONS OF APPROVAL
1. The installation of the sewage disposal system and retaining wall must be supervised and certified
by a licensed design professional (Form WWM-073 enclosed).
2. This permit and plan is subject to approval by the Town of Southold for grading and drainage.
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