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Home My WebLink AboutDaSilva, Jack ELIZABETH ~. NEV~,I~E ToWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT 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 southoldtown.nor~hfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: 31J~ ~ ~(~/t~ld Town Building Departmem FROMM: Lin.d.:~...CoopSr, Southold Town Clm'k's Office I~TI~: ~ June 24, 2004 Transmitted herewith is a copy of application No. 3339 for a Cesspool/Septic Tank Construction Permit subm/tted by: x Steven Cataldo for Jack DaSilva 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 Dated E~,IT, ABETH A. NEVILLE TOWN CLEP,,K REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION 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 southoldtown.northfork.net Residential ~ $10 __ or Non-Residential ~ $25 __ Application No..~'-~ _~ Permit No. Applicant Name Applicant Mailing Address Septic Tank or Cesspool Brief Description of Proposed Construction or Alteration Location of Proposed Construction/Alteration: Owner of Property: ,~-x C_~,~. ~ Owner Mailing Address: ~ C_~r'~ Owner Property Address: -?~_ ~c~! Name and phone number of contact person ~ TaxMapNo: 1Oo~ Section ~., Block ~ Lot Cross Street CC-t-- 2_ ~ NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION SURVEY WITa m ALm APPROVAL r--~gnature of Apphcant Date Receivedl~y:. ~ {~/~f~~,