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Home My WebLink AboutScheidet, Robert ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF IN~FICER OFFICE OF THE TOWN CLERK '~ ~ I $ ~ ', TOV~N OF SOUTHOLD O~ ~,!' ~,'-:Souihold Town Building Department Town Hail, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.nor t h fork.net FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: April 12, 2004 Transmitted herewith is a copy of application No. 3302 for a Cesspool/Septic Tank Construction Permit submitted by: Robert Scheidet 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: Signature ELIZABETH A. I~VILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INF~ORMY~ION OFFICER d/ - /~ SOUTHOLD WASTEWATER DISTRICT ~4 APPLICATION Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.northfork.net CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK / Residential ~ $10 Jot Non-Residential ~ $25 Applicant Mailing Address Septic Tank or Brief Description of Proposed Construction or Alteration Application No.~9'~ _ Permit No. Location of Proposed Owner of Property: Owner Mailing Address: Owner Property Address: /(qc~.~_C/~'a.~x e,,/'~ Name and phone number of contact person Tax Map No: Section ~76 Block /0 Lot ~-~, ~ Cross Street NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW SURVEY VCLT4I II ALTH DEPARTMENT APPROVAL CONSTRUCTION REQUIRESS' :~~'- ' Date ~/~/7~-D5/ Received l~y: SUbdIVISION M~P~OF "SOUT~I~OOD 'ION INSPEIDTION FOR SANITARY BY HEALTH DE PARK WAY + 306,10' GAGEN'S LANDING ROAD r -o~-O/z'~