HomeMy WebLinkAboutZimmer, Frank REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FRE EDOIVLOE-INF. O P,/V~TION OFFICER
r rO ~. 0 ~(~ ,~:: OFFICE OF THE TOWN CLERK
i ~ ,~ TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 1179
Southolcl, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northt'ork.net
TO:
Southold Town Building Department
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED: February 20, 2004
Transmitted herewith is a copy of application No. 3284 for a Cesspool/Septic Tank Construction
Permit submitted by:
Stacey Bishop for Frank Zimmer
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 remm it to me.
Linda J. Cooper
I have reviewed the application anO location map of th{ project cited above and make the following
recommendations:
APPROVE '
DISAPPROVE
Datecr / '
I~I,IZABETH A. NEVILLE
ToWN CrJ~RK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFOP~ViATION OFFICER
Town 'Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldt own.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTMOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 ~/ or Non-Residential ~ $25 __
Application No.'~
Permit No,
Applicant Name -~C:/~ co-/
Applicant Mailing Add:ess
Septic Tank ,~- or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person
Tax Map No:
Cross Street
Block ~:~,~ Lot "7- ~
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Received 6y:
Si~/~ of Applicant
/Date
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