HomeMy WebLinkAboutKidby, GeorgeTown Ha]]; 53095 1VIaiu Road
P.O. Box 1179
Southold, New York 11971
Fax (691) 765-6145
Telephone (681) 765-1800
OFFICE OF THE TOW~N CLERK
TOWN OF SOUTItOLD
TO: Southold Town Building Departmcnt
FROM: L'mda J. Cooper, Southold Town Clerk's Ollice
DATED: May 26, 2004
Transmittc~l herewith lg a copy of application No. 3323 for a CesspooYSeptic Tank Construction
Permit submitted by:
Mmazl Homes, Inc
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 below and return it to me.
Linda J. Cooper
I have reviewed the application and location map of the project cited above and make Se lbllowing
reconm~endstions:
A~PROVE
DISAPPROVE
Signature
Dated
TOWN OF SOUTBOLD
Cons~ruction
Alteration
~10. O0 - Residential
S25. O0 ~ Non-Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
APPLICANT ADDRESS:"~-O
SEPTIC ~ESSPOOL
DESCRIPTION Of PROPOSED CONSTRUCTION,-:OR A~TERA~ION
LOCATION MAP: Must be attached hereto before permit may be issued,
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION;
OWNER o~ PROPERT*: . ¢~¢_.C~%~ k~-ck_~ .
OWNER MAILINO ADDRESS; L.~' Lc~3~,~,_k ~o~ ..
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PER$ON;
TAX ~AP ~o.~ S,,tio. ~( B~k f~
CROSS STREET; ~' ~I~% ~,~
BU LDING PERMIT NUMBER CROSS REFERENCE;
RECEIVED
DATE:
Signature of~C~plicant