HomeMy WebLinkAboutJ & C Holdings ELIZABETH A~: ~iyEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
~.GE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOI~ .OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southold~own.nor thfork.ne~
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO:' Southold Town Building Department
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED: July 26, 2004
3354
Transmitted herewith is a copy of application No.
Permit submitted by:
3354 for a Cesspool/Septic Tank Construction
J & C Holdings LP
Please review thc 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 l~¢ation map of the project cited above and make the following
recommendations: ~ J
APPROVE ~
DISAPPROVE
Corem ents:
Signature
Dated
EI,IZABETIi A. NEVII.I,E
TOWN CLEltK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICEll
RECORDS 1VI/LNAGEMENT OFFICER
FREEDOM OF INFORMATION OF/~'ICER
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
sou~holdtown.nor~hfork.net
Residential ~ $1 0
Applicant Name
Applicant Mailing Address
__ or Non-Residential @ $25 __
Septic Tank or Cesspool /
Brief Description of Proposed Construction or Alteration
Application No. ~_
Permit No.
Location of Proposed Construction/Alteration:
OwnerofProperty: ~-4 ~' /(O~./)fa/¢ $ Z. ff'9
Owner Mailing Address: /0~ O, ~O ~ /r7 Zf
s'oa?/e3z.~ / ME //77/
Owner Property Address: ~,, g ~- ' [ ~~-:~
Name and phone number of contact person '~/~ ~'- ~ 2~2 0 .5~5'-,- Z/(3/
TaxMapNo: [OdOSectionlf~ Block (.// Lot
Cross Street mt~t'~ ~0~ t3 [ .r/~ ..~
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
~ONSTRU~TiO~~ ;S~VE~ WI~ I31~EA~TH-DgPARTMEN-T ~PRovAL
Received lJy:.
// , ·
T~e Joc~ltiofls of wells ~
$[~w~ ,~.ereoa ere .~fem field ob~erv~ns
ONLY
- .
LOT ~
NOTe
,~UIB~UR~ACE