HomeMy WebLinkAboutMoglia, John ELIZABETH A. NEVILLE
TOWi~ CLERK
REGISTRAR OF 'vITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P,O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO:
FROM:
DATED: March 22, 2004
Transmitted herewith is a copy of application No.
Permit submitted by:
John Moglia
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
3293 for a Cesspool/Septic Tank Construction
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.
Linda J. Cooper
I have reviewed thc application and location map of the project cited above and make the following
recommendations:
APPROVE J
DISAPPROVE
Comments: ~
Dated
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFOPdMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
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
Applicant Name -~f/E/
Applicant Mailing Address
,1177
Septic Tank or Cesspool.
Brief Description of Proposed Construction or Alteration
__ or Non-Residential @ $25 __
/0
Application No. g~./.q ')
Permit No.
/ /
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:
Owner Property Address:
Name and phone number o.l~contact person
Tax Map No'//OcX) ( S;cti)~ ?~. Block S~--~ Lot ~
SignaliZe o~f Appl'lc~4d Date
Received I~y: ~~-/k