HomeMy WebLinkAboutChristie, John Scott ELIZABETH A. NEVII J,E
TOWN 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
TO:
FROM:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
DATED: March 24, 2004
Transmitted herewith is a copy of application No. 3296
Permit submitted by:
for a Cessp~ ol/Septic Tank ALTERATION
Morris Cesspool for John Scott Christie
Please review the application and location map and advise il' the project l~s 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 and location map of the project cited abo', c and make the following
recommendations:
APPROVE /
DISAPPROVE
Comments: M[aintain required setbacks from adiacent wells, buildings, property lines and water
P~dies. EXCAVATiONINSPECTIONR~ ,,UL,ED.
Signature
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT 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
FREEDOM OF INFO~ATION ~CER
~'~'/t'~l~ ~*'~. ,f, ~' OFFICE OF THE TO~ CLERK
~ ' ~ ~ ~NSTRUCTION or ~TE~TION PE~IT M ~ ~ ,f~ CESSPOOL or SEPTIC TANK
~idcntial ~ $10 or Non'Residential ~ $25 Application No.
Pe~it No.
Applicant Nme ~,~ ~r~o ~
Applic~t Mailing Address .~7~ ~"~c~- F,~
Septic T~ or Cesspool ~
Brief Description of Proposed Cons~ction 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: Section / c///
Cross Street
Block ~ Lot ?
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Received by: ~'
Signature of Apphcant
Date