HomeMy WebLinkAboutArcher, Bill : ELIZABETH A. NEVILLE
TOWN CLERK .
REGISTRAR OF ~fIT~X-L STATISTICS
MARRIAGE OFFICER
RECORDS MAi~AGElk~ENT OFFICER
FREEDOM OF INFORALkTION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Th: ~.&::_~:~o_~t_hgt/~o~m~uilding Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 21, 2004
Transmitted herewith is a copy of application No. 3352
Permit submitted by:
Bill & Barbara Archer
Town Hall, 53095 MaSh Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
sour h oldt~vn.nor t l-fro rk.ne t
for a Cesspool/Septic Tank Construction
Please rexdew the application and location map and advise if the project has receRred Suffolk Comxty
Health Department ap.proval 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
recomme~,dations: ~'~ project cited above and make the following
APPROVE
DISAPPROVE
Comments: ~
Dated
..~'0¢,~ICE,. OF TIlE TOWN CLERK
Town of Southold
Judith T'. Terry, Town Clerk
· 'Town ttall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971
Telephone
[516) 765-1801'
/O ' TOWN OF SOUTHOLD
/ UTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION,
for
$10.00 - Resldel~tlal
~25.00- Non-Residential
OPERATION PERMIT
SEPTIC· TANK or CESSPOOL
Operation Permit No.
Fee $
OWNER NAME: ~i/--~ 4
OWNER MAILING ADDRESS:
DATE
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER:
CF,
TAX MAP NO.: Section Block
CR055 STREET: '
Lo[ ~-Cl~', /
TYPE OF SYSTEM: Septic Tank
New ¢ Existing
Cesspool
Residential
New Existing
Non-Residential
LOCATION MAP:
Must be attached iiereto before permit may be Issued.
(Locale building end system; give north arrow and feet
of distance, approximately, to building-and closest road..)
'~~g~nature of Applicant
Town Clerk's Office
!:~."' >' '='_ o ~
'Il.
/
/