HomeMy WebLinkAboutBradley, John · '~JZABETH A. NEV[I,I.E
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECOB2)S MANAGEMENT OFFICER
FREEDOM O~.~.mF~~ OFFmER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Town Hall 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldt own.nor~h~ork.net
T~O:
FROM:
DATED:
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
April 16, 2004
Transmitted herewith is a copy of application No. 3308 for a Cesspool/Septic Tank Construction
Permit submitted by:
Jeffrev Butler
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if tlfis office may issue the permit.
Please complete the form below and return it to me.
Linda J. Cooper
I ha-~e reviewed the application and location map of the project cited above and make the following
recommcmdations:
APPROVE J
DISAPPROVE
Comments:
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTILk~ OF ViTAL STATISTICS
MARRIAGE OFFICER
P~CORDS MANAGEMENT OFFICER
FREEDOM OF IITFORMATION OFFICER
Town Hall, 53095 Main Road
P,O. Box ~79
Southold, New Yd~k 11971
Fax (631) 765-6145
Telephone (631) 765-1800
sou~holdtow~,northfork, net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTItOLD WASTEWATER DISTRICT
APPLICATION
Residential ~ $i0
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
or Non-Residential ~ $25
Permit No.
Location of Proposed Construction/Alteration:
"Owner of Property: ~/0~-~/ /~/Z~,/;2Ae,~
Owner Mailing Address: fig, O, ~efv.~ ~ ~
Owner Property Address: ~o-~ -~y ~ ~/~
/
Name and phone number of contact person ~/~
Tax Map No: Section,-/~ s~ Block Z/
CYoss Street ,~ ~/'~
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Si Date
Received
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