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HomeMy WebLinkAboutHallock, Jeff ELIZABETH A. NEVILLE 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 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: March 31, 2004 Transmitted herewith is a copy of application No. 3300 Permit submitted by: for a Cesspool/Septic Tank Construction Donald Connoll¥ for Hallock 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 the application and location map of the project cited above and make the following recommendations: APPROVE ~ DISAPPROVE Comments: Dated ELIZABETH A. NEVILLE TOTM CLERK REGISTP. AR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFOtLMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 South~ld, 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 ~or Non-Residential ~ $25__ Application No. Permit No. Applicant Name Applicant Mailing Address Septic T~r Cesspool. Brief Description of Prop0sed Construction or Alteration Block ~ Lot / / Location of Proposed Construction/Alteration: Owner of Property: .'-J-~Yf? /-/q/Jr>C/r-- Owner Mailing Address: Owner Prope~ Address: Name and phone nmber of contact person Tax Map No: [~ Section Cross S~eet ~"~B]~ NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL ature of Applicant / Date Received 'dO~a