HomeMy WebLinkAboutAlvarez, RogerOFFICE OF ~ TOWN
TOWN OF SOUTHOLD
TO:
FROM:
DATED: May 5, 2004
Transmitted herewith is a copy of application No.
Permit submitted by:
Roger ANarez
Southold Town Building Department
Lin& J. Cooper, Southold Town Clerk's Office
Town Hall, 5:t095 Main
P.O. Box 1179
$outhaid, New York 11~71
F~ (~31) 78~-~145
Taiephone (~31) 7~5-1800
southo]d~o~.no~ork.nei
3314 for a Cesspool/Septic Tar~ Construction
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 beloxv and return it to me.
Lin& J. Cooper
I have reviewed the application and location map of the project cited above and make the folloxving
recommendations:
APPROVE /
DISAPPROVE
Comments: '~:~~~~_
Signature
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (831) 785-6145
Telephone (831) 785-1800
southoldtown,norihfork,net
OFFICE OF TIlE TOWN CLER~
TOWN OF SOUTHOLD
SOUTtlOLD WASTEWATER DISTRICT
APPLICATION.
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 or Non-Residential ~ $25 __
Applicant Name
Applicant Mailing Address ~_ ~+)~.) ~" '~
Septic Taak X or Cesspool &
Brief Descripfi6n of Proposed~/~onstruction or Alteration
Appliea~on No. '};lq
Permit No.
Location of Proposed Constructioh.n~_Iteration:
Owner of Prope~y:
Owner Mailing Address:
O~= Prope~ Ad&ess:
Nme ~d phone n~ber of contact person
Map No: Seo~o~ l ~ t' ~ook ~o, I d~. ?
Cross Street
NOTE: LOCATION i~¢LiP ~ BE SUBIVIIT~TH AP?LICATION. NEW
. ~ ~ Siva :e of Applic~t~ Date
Received ~;;~¢ -