HomeMy WebLinkAboutGold Creek Building ELIZABETH A. NEVIT~T,~..
TOWN CLEHK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
HECORDS AflANAOEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall 53095 Ma/n Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
sou~holdtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PER3.HT
CESSPOOL or SEPTIC TANK
Residential (~ $10
Applicant Name O4.1g
Applicant Mailing Address
__ or Non-Residential (~ $25 __
1o'70 Oepo-}
Application NO. 3 ~{~
Permit No.
Septic Tank or Cesspool /
BriefDescriptionofrroposedConstmetionorAlteration Yea./ [ ~'~v~ per,
Location o£ Proposed Constmction/Alterali~on:
Owner of Prorerty:
Owner Mailing Address:
Owner Property Address: :~-^-~ ~ e- b~u<
Name and phone number of contact person D 0/~ ~'~ ¢
Tax Map No: I O~06 Section 1~//~0 /qBlock Ot Lot
ro OC~ ·
C ssS~eet ~a~n
NOTE: LOCA~ON 5~ ~ST BE SUB~ED %~ ~PLICATION. ~W
CONSTRUCTION ~Q~S S~Y ~TH ~TH DEP~T~NT ~PROV~
Silage of App~c~t Date
R~eived 6y: _; _ -
F;LIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
~AI~IAGE OFFICER
RE C O RD ~ ~,[A.NAC~EMEN T OFFICER
FREEDOI~ OF INFOi~f~kTION OFFICER
· Town Hail, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.north£ork.net
TO:
FROM:
DATED:
RE:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building Department
Lind~ J. Cooper, Southold Town Clerk's Office
August 18, 2004
Cesspool Construction Application
Transmitted herev~4th is a copy of application No.
Penuit sttbmitted by:
Gold Creek Building Compare~
3366 for a Cesspool/Septic Tank Construction
Please review the appli~ation 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 the project cited above and make the following
recommendations:~ /
APPROVE
DISAPPROVE
Comments:
Signature