HomeMy WebLinkAboutSeeley, Barbara ELIZABETH A. NEVILLE
TOWN CLERK
REGISTtL~kR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS 1ViA~AGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtownmorthfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO:
FROM:
DATED:
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
June 9, 2004
Transmitted herewith is a copy of application No. 3332
Permit submitted by:
for a Cesspool/Septic Tank Construction
Tabatha Bailey for Robert & Barbara Seele¥
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 the following
recommendations: ~
APPROVE
DISAPPROVE
Comments:
Signature
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTBAR OF VITAL STATISTICS
MARRL~GE OFFICER
RECORDS MANAGE1V~NT OFFICER
FREEDOM OF INFOILMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
sou~holdtowm nor~hfork.ne~
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 or Non-Residential ~ $25
Applicant Nam-~---~~-~-~ k.~-.~
Applicant Mailing Addres~'-'~z~',r ~
Application No. 33 3 ~x
Permit No.
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B/.mfDcscripfion of Proposed Construction or Atterafionw-~__~.~ ~-xt ~ ~,
Location of Proposed Construction/Alteration:
· O~vner of Prope~.
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person'-'~-Cxk._~k-~'XCx~-x-X'~ ~k¢~..(
Tax Map No: Section ,~ .~:~-'~
Cross Street %,-~"X'-~/'\-xce_
NOTE. LOCATION ~ MUST BE SUBMITTED ~'ITH APPLICATION. NEW
/~f'l Signature ~)f Ap~gli~mt "D~te
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