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Home My WebLink AboutRerisi, Gail :EL~i~BETH ~. NEV~,T,F, TOWN CLERK REGZSTKAR OF VITAL STATISTICS · -lriARRIAGE OFFICER RECORDS NIA2~AGEMENT OFFICER FREEDOM OF IIgFORA~4.TION OFFICER OFFICE OF THE TOWN CLERK' TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Town Hall, ~3098 Main Road P.O. Box 1179 Southold, New York 11971 Fax {6~!).. 7.6~-{~14:5 .... Telephone (6B1) 765-1800 sou~holdh~m~aor~Bfork-net Residential @ $10 ~( or Non-Residential @ $25 __ Applicant Name C,4/~ /~,e_/5/ Appl'icant Mailing Address ~ ~7--~/6'e Septic Tank ~ or Cesspool Brief Description of Proposed Construction or Alteration Application No. 3~ Permit No. Location of Proposed Construction/Alteration: Owner of Property: ~;,/~ -. Oxxmer Ma/lNg Address: 05- Owner Property Address: Name and phone nttmber of conlaet person TaxMapNo: Ioo0 Section d=t~g~7~ Block Cross Street ]lh*t~ Lot NOTE: LOCATION ~{AP MUST BE SUBMITTED ~VITI{ APPLICATION. NEW CONSTRUCTION REQ_UIRES~q_URVEY *WITI~, HEAI~IIEP A R TJ~ENI~_P. PJlD_I£AL ..... Si~ature of Appff&nt Date ' Recei,red b,.: ~ ~ ~--.z-k~ ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS A LA-i%RL~GE OFFICER REco~vs ~U~E~N~ OF~CE~ ~i -'~ ~ . i OFFICE OF TIlE TOWN CLERK ~,:" ~1. 2 S ~ TOWN OF SOUTHOLD TO eL ........ partm :,. ,: ~_8~mtho~&q~O~vn-Bi~ding De ent Town Hall, 53095 Main Road P O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.nor tkfork.net FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: July 23, 2004 Cesspool Construction Application Transmitted here~vi[h is a copy Of application No. 3353 for a Cesspool/Septic Tank Construction Permit submitted by: Gail Rerisi Please review the a~plication and location map and advise if this office may issue the permit. Please complete the form below and return it to me. Thank you. I have reviewed the application and location map of thc project cited above and make the following recommendations: APPROVE ~ DISAPPROVE Comments: Signature a~~_~~~d--~'~ ' .2) .z~ D ]