HomeMy WebLinkAboutGonzalez, Jewel REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Building Department
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy ofapphcation No. 3310
Permit submitted by:
Jewell Gonzalez
Town Hall, 53095 Main Road
P.O. Box .1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (63!) 765-1800
sou~holdt own.nor~hfork.net
for a CesspooVSeptic Tank Construction
Please review the application and location map and advise if the project has received Suffolk County
Health Deparuuent approval and if this affice may issue the permit.
Please complete the form below and return it to me.
Linda I. Cooper
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE J
DISAPPROVE
Comments:
Si~aature
ELIT~BETH 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, NewYork 11971
Fax (631) 765-6145
Telephone (631) 765-1800
soufl~oldtown.nor thfork.net
OFFICE OF THE TOWN CL~,,RK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residentia1 ~ $10_~.~_ or
Applicant Name ~"~ac~y
Applicant Mailing Address
Non-Residential ~ $25 __
Application No.
Permit No.
Septic Tank or CesSpool
Brief Description of Proposed Construction or Alteration t, Jc-~0 ~"/,~6cc-- /~nc~/ /~toc'~,~.,C
Location of Proposed Construction/A_Iteration:
Owner of Property: ~oc-,oc--~_~_
Owner Mailing Address: 73~o t~rqw~,/~c~ D~.-
Owner Property Address: ~ ~,F(~ -
~N~me ~d phone number of contact persOn
Tax Map No: /00 0 Section '7 ? · Block
Cross Street /~, ~ '-~a~JVl~o
NOTE: LOCATION MAP MUST BE SUBMITTED WITH' APPLICATION- NEW
CoNsTRuCT~ON'R~QtmmS SU~wy WITH ~EALTH DEPARTM~NT:~. ~'ROWa~
' Ddte
' ~" Si~e of~pPncmt
R~eived ~y: ~,~~ '