HomeMy WebLinkAboutCorrazini, Richard JrTown HsJl, 53095 M~dn Road
P.O. Box 1179
Southold, New York 11971
Fax (~31) 705-6145
Telephon~ (631) 765-1800
southold~o~.no~ork.net
@FFECE OF TEE TOWN CLEI:~E
TOWN OF SOUTHOLD
TO: $outhold Tovca Building Department
FROM: Lin& J. Cooper, Southold To~vn Clerk's Office
DATED: May 4, 2004
Transmitted herewith is a copy of application No. 33~3
Perr~t submitled by:
for a Cesspool/Septic Tank ConsWaction
Rfchard Corazzinl Jr
Please review the application and location map and advise if the project has received SuffoLk County
Health Depar[ment 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
Signature
Dated
ELIZABET~ A. NEVILLE
q~OWN CLER~
REGISTt:kA~ OF VITAL Sq~ATISTICS
MARt{L~GE OFFICER
RECORDS MA/qAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Sou~hold, New York 11971
Fax (631) 765-614:5
Telephone (631) 765-1800
soulhaldtown.nor~hfork.net
OFFICE OF TIFIE T@WN CLE]~I4
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DIST~CT
~PL[CATION
CONSTRUCTION ~r ~TE~T~ON PE~T
CESSPOOL ~r SEP~C T~K
Residential ~ $10 or Non-Residential
Permit No.
Applicant Mai14ng Ad&ess ~-O~
S~tic T~ or Cesspool /
Brief Description of Proposed Cons'~ction or ~terafion
Location of Proposed Construction/Alteration:
Owner of Property: :~'7~'~
Owner MailLng Ad&ess:
Name and phone namber of contact person
Tax Map No: Section /~/ Block ~T_ Lot /~
NOTE: LOCATION ~ ~ST BE S~TTED W~ ~PLICATION. NEW
CONSTRUCTION ~Q~S S~~~ DEP~NT ~ROV~
S~a~e of App~t Date
R~eived ~y: