HomeMy WebLinkAboutMiller, KevinTown Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631j 765-6145
Telephone (631] 765-1800
southoldtown.northfork.net
· 'OFFliCE OF THE TOWN CLERK
~}/ - 3 ~[}~ TOWN OF SOUTHOLD
TO: South01d~Towfi Building Deparuuem
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED: May 3, 2004
Transmitted herewith is a copy of application No. 3312
Permit submitted by:
for a CesspooVSeptic Tank Constraction
McCar~hV Mana~emen~
Please review the application and location map and advise if the project has received Suffolk County
Health Department approvaI and if this office may issue the permit.
Please complete the form below and return it to me.
Linda J. Cooper
! have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
Signature
EL~ETI~ A. N~VILLE
TO~ CLERK
REGISTRAR OF VIT~ STATISTICS
~R~GE OF~CER
RECO~S ~AG~NT O~ICER
~EEDOM OF ~NFO~TION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.ne~:
OFFICE OF Tt{E TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 ~,,' or Non-Residential ~ $25
Applioant Name
Septic Tank
~f Desci~pfi~n of Proposed Cons~ction or Alteration
~cation of Proposed ~ctio~teratio~:
N~e ~d phone n~b~r of ~ontaot
T~ Map No:
Cross S~eet
NOTE: LOCATIO~ ~ ~ST
CONSTRUCTION
Application Not_F)3 ( L
~/~X'- Permit NT.
NEW
Received by:
Date
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 05/03/04
Transaction(s):
Septic Permit - Construct - Resid.
Receipt:
3051
Subtotai
$10.00
Check#: 3051
Total Paid:
$10.00
McCarthy, Management
46520 Route 48
Southold NY 11971
Clerk ~D: LYNDAB In[emal ID: 93233
~ ~OAD
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