HomeMy WebLinkAboutDarin, Gabriel~,-~EIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
ML~RRL~GE OFFICER
RECOHDS I~LkNAGEi~ENT OFFICER
FRE E~D O~M O F~_F_~U~IE~-~ FICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
T :Oe-~ .... Southold Town Building Department
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED: August 31, 2004
Transmitted herewith is a copy of application No. 3371
Permit submitted by:
Tow~a Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldto~m.nor thfork.net
Brooke Epperson
for a CesspooL"Septic Tank Construction
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 reviexved the application and location map of the project cited above and make the following
recommendations: ~
APPRO\rE
DISAPPROVE
Comments:
I~LIZABETH A. NEVILLE
TOWN C LEP. K
REGISTRAR OF VITAL STATISTICS
MARRLkGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF IITFORMATION OFFICER
To%~rn Hall, 53095 Main Road
P.O. Box 1179
SouthoId, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.nort hfork.net
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 __
Application No. ~ ~ ? !
Permit No.
Applicant Name ' ~4~-~=-n-~g-~~ $ {P
Applicant Mailing Ad,ess ~, 0 - ~' ~ ~
Septic T~or Cesspool ,
Brief Description of Proposed Construction or Alteration ~ ~w, ~
Location of Proposed Cons~ctioM~ter~on:
Omer of Property: ~¢Wl ¢[ '~ ~
O~erMh~gAd~ess: ~,~. ~
O~xmcr Prope~ Address: ~~ m ~ ,
Name and phone nmber of contact person ~t ~', ¢~ ~ OX~
T~ Map No: Section ~ Block ~ Lot
Cross S~eet ~~ ~ -
NOTE: LOCATION ~ ~ST BE SUB~HTTED ~H .~PLICATION.
CONSTRUCTION ~Q~S S~%~Y I~TH HE~TH DEP~T~NT ~PROV~
Si~ffmre of Applicant Date
O~