HomeMy WebLinkAboutGreenbriar Homes ELIZABETH A. N-EVII,I,E.
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
IViAHKIAGE OFFICER
· RECORDS MANAGEIVIENT OFFICER
FREEDOM OF INFOKMATION 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
TO:
FROM:
OFFICE OF ~ TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building Department
L/nda J. Cooper, Southold Town Clerk's Office
DATED: June 16, 2004
Transmitted herewith is a copy of application No. 3336 for a Cesspool/Septic Tank Construction
Permit submitted by:
Greenbriar 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 tlie form below and ream 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:
Dated
E .LIZA~E'rid A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
' RECORDS MANAC~F2ViENT OFFICER ._
FREEDOM OF INFORMATION OFFICER
Town HaLl, 53095 Main Road
P.O. Box 1179
Sou~hold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.no~l~ork_net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD wASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
ResidentiaI ~ $10 J or Non-Residential ~ $25 __
Application No. ~ ~ ~ ~
Permit No.
Location of Proposed Constmction/Alieration:
O er of Prope
Owner Mailing Address :..-~'~ /~z~,~/-t/~,"/~)/a.~ ~- ~_~
Owner Property Address: ,~- ,,~ t.,/~,~r/-~ 7~f/-~/ ~-~ / ~/~Y~-~F~__ /l~) ,L'd'
Name and phone number of contact person
Tax Map No: Section /~--~,
Cross Street Zr~u"/~----~ ~T.
Block / Z- Lot j
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
. CONSTRUCTION REQUIRES SURVEY~,WVrHJd~EAL, TH, DEPARTMENT APPRQ_VAL
· /./ ~__.~,e.,~-/,~e._ .z,~,.~,~_~
Signature of Applicant Date
............. q ~