HomeMy WebLinkAboutAnemoyanis, Vivian TOWN CLERK
REGISTF,~,.R OF VITAL STATISTICS
RL~RL~GE OFFICER
,,.'.- t .i
OFFICE OF TIqrF. TOWN CLERK
TOWN OF SOUTI-IOLD
Town Hall, 53095 MR~n Road
P.O. Box 1179
Southold~ New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
sou~holc~town.northfork.net
TO:
FROM:
DATED: Augnst 3 I, 2004
Trmxsmitted herewith is a copy of application No.
Permit submitted bT.
Vivian Anemoyanis
Somhold Town Build'rog Department
Linda J. Cooper, Somhold Town Clerk's Office
3370
for a Cesspool/Septic Tank Construction
Please review the application and location map and adxdse if the project has received Suffolk Cmmty
Health Department approval and if this office may issue the pem~it_
Please complete the form below mhd 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 /
DISAPPR.OVE
Comments:
D~ted ~
ELIZABETH A. NEVILLE
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
I{ECOP~S/VLaNAGEMENT OFFICER
FREEDOM. OF INFOP~ATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD %VASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Town H~ll, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6146
Telephone (631) 765-1600
sot/tholdtowamnortlffork.net
Residential ~ $10 or Non-Residential C~ $25 __ Application No. -~ ~ 70
Permit No.
Applicant Name ':,./i ~/iO ~ ~//~ ~ "0--~"'~ 0 '4 ~
Septic Tank /or Cesspool~ '
Brief Description of.l~roposed Construction or Alteration /]J~/~ [ O~ !
Location of Proposed Con~tmction/Alteration:
O~erMallingAd~ess: .~ q 5 /~., ( XOS~ ~ y/~
' ,
Nme ~d phone number of contact person U '
z~p~o:j~ s~io~ ~) ~o~ ~ rot~
NOTE: LOCA~N ~ MUST BE SUBmiTTED ~TH ~PLICATION. NEW
'CONSTRUCTION ~Q~S SURLY ~TH HE~T~ DEP~T~NT ~PROV~
gi~ of X¢~ ~at~