HomeMy WebLinkAboutNine, Robert TOWN ~
~s~ OF w~ ST~ISTICS
i.j ~aREOORDS 1ViANAGE1YI~NT OFFICER
~ '~OM OF ~T~ON OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax ~631) 765-6145
Telephone (6317 765-1800
southoldt own.nor~hfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
[~ Building Deparm~em
FROM: ~inda I. Cooper, Southold Town Clerk's Office
DATBD: April 5, 2004
Transmitted herewith is a copy of application No. 3301 for a Cesspool/Septic Tank
Constmctioa~ermit submitted by:
Robert & Janiqt~e Nine
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 and location map of the project cited above and make the [bllowing
recommendations:
APPROVE /
DISAPPROVE
ComiTl.erl[s: ~
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
- MARRIAGIil OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Halt, 53095 iVlain Road
P.O. Box 1179
Southold, New York 11971
Fax (6~ 76.5-61,15. : .
Telephone (631) 765-1800
southoldtown.northforl~ne~
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 ~Z'C 4 3a~C ~:T_33C
Applicant M~ling Ad.ess 90 ~X 1~O t
Septic T~ ~ or Cesspool ~
~escfiption of Proposed COnsmction or Alteration
Location of Proposed Construction/Alteration:
OwnerofProperty:. ~r + ~t'4~x<~u~
- Owner Mailing Address: ~ ~ \t'{0 [
Owner Property Address: .[I ~C0 50
Name and phone number of contact person
· Tax Map No: Section \\M~ Block \\ Lot
Cross Street ~h ~.u,o
NOTE: LOCATION MAP MUST BE SUBMITTED WITIt APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT AppRovAL
Received by:
Signature of Applicant
Date
-
New S~c~' Avenue
JO~ C. E~ERS L~ SURVEYOR