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
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