HomeMy WebLinkAboutDoll, Edna REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS 1VL4.NAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southotd, New York 121971
Fax (621) 765-6t45
Telephone (631) 765-1800
southoldtown.northfork.net
TO:
FROM:
3
~ICE OF Tm TOWN CLERK
TOWN OF SOUTHOLD
..... ~o~th~Id Tow~ Buil~iing Department
Linda J. Cooper, Southold~Town Clerk's Office
DATED: May t3, 2004
Transmitted herewith is a copy of application No. 3318 for a Cesspool/Septic Tank Construction
Permit submitted by:
Ma Tine~
Please review the application and location map and advise if the project has received Suffolk Comnty
Health Department approval and if this office may issue the permit.
Please complete the form below and return it io me.
Linda J. Cooper
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE J
DISAPPROVE
]~LIZA~ETH A. NEVILLlg
TOWN
REGISTRAR OF ~T~ STATISTICS
~GE OFF~CEB
RECO~S ~A~E~ENT OFFICER
F~EEDO~ OF INFO~TION
~ ~_~ ~ ~ o~c~ o~,~ ~o~ c~
~ SOD~HOLD ~AS~A~ D~ST~CT
~PLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Town Hall; 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoidtown,nor~hfork,net
Residential ~ $10
__ or Non-Residential ~ $25 __
Application
Permit No.
/Jc ~J
Name and phone number of contact person
Tax Map No:/600 Section /2 Block
Cross Street [f~/~rl.u~ /_f ~/ad F~6~t9
NOTE: LOCATI[ON BI&P MUST BE SUBMITTED WITH APPLICATION. NEW
~ ~ s~^~ph%ant
CoO~Id Er
~ T
EL £ VA TI[J,
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SUR YEY
AT ORIENT
TO ~N OF
SUFFO~ COUNTY,
OF PROPERTY
YORN
sion Hoz~d Ll~e from
78
160'
!,942
!E LINE
~$ f~EFEREN~ED TD T~P[~GRAPHIC M&P OF FIVE
tOWNS g N,G,V,D,
.IB F~ THIS
(63I)
i230
SDUTHDLD,
11971
ND: 49618
,6~63D 765-i797