HomeMy WebLinkAboutHayes, John ELIZABETH A. NEVILLE
TOWN CLERK
EEOISTRAi~ OF VIT.~L STATISTICS
3~L~RIAGE OFFICER
RECORDS R~kN-AGEMlgNT OFFICER
FREEDOM OF INFOR~L_~ION OFfiCER
J~J~ 3 ~ ~ _ OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: ~a~tll~ol~ T~VSi B mlding Department
Town H~ll, 53095 Main Road
P,O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.nor~h£orkmet
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 30, 2004
Transmitted herewith is a copy of application No. 3357 for a Cesspool/Septic Tank Construction
Permit submitted by:
Uellendahl for John Hayes
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
recomm~endations: J
APPROVE
DISAPPROVE
Signature
Dated
I{EGISTRAR OF %rITAL STATISTICS
MARRIAGE OFFICER
HE CO RD S. MA/q'AGEIvIENT OFFICER
FREEDOM .OF INFORAC~TION OFFICER
Town Hal~ 53095 M,i,~ l%oad
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
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OFFICE OF ~ TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PER3'HT
CESSPOOL or SEPTIC TANK
Residential ~ $10 /: or Non-Residential ~ $25 __
Application No:~ '~"D'''')
Permit No.
Applicant Name
Applicant Mailing Address
Sept{c Tank v/ or Cesspool
Brief Description of Proposed Construction o?Alterafion
O~mer of Property:
Owner Ma'fling Address:
Owner Property Address:
Name and phone number of contact person
Tax Map No:/~O Section /.~
Cross Street fi;~'/'7 /~g/:/7~D
Location of Proposed Construction/Alteration:
Block O....~ Lot ~. 20
NOTE: LOCA~ON 5~ MUST~b~S~SH~D ~ ~PLICATION. ~W
CONSTRUCTION ~Q~S S~~TH~TH DEP~NT ~PROV~
S ~ ~Apph~t Date
Receiv~ ¢~
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