HomeMy WebLinkAboutCannone, I TO,tN CLERK
REGI.qTRAR OF VITAL STATISTIC8
MARRIAOI~. OFFICER
P~ECORDS i~qAGEIVIENT OFFICF. R
FREEDOM 0F INPORMATION OFFICER
OFFICE OF TH~: TOWN CLERK
TOWN OF SOUTHOLD
Town Hall 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
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"TO:
FROM:
DATED: July 9, 2004
Transmitted herewith is a copy of application No.
Permit submitted by:
I. Cannone
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
3345 for a Cesspool/Septic Tank Construction
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 fohn below and return it to me.
Linda J_ Cooper
I have reviewed the application and location map of thc project cited above and make the following
recommendations:
.
APPROVE
DISAPPROVE
Comments:
.. ELIZABETH A. NEVILLE
' ~:'~ TOWN CLERK- '
REGISTRAR OF VITAL STATISTICS
MABIq~,GE OFFICER
RECORDS 1ViAlqAGEM~NT OFFICER
FREEDOM OF I~FOIL~TION OFFICER
Town Hal~, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone ~(631) 765-1800
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ 510 ~/ or Non-Residential ~ $25 __
Applicati;n No. ~ t~~--
Permit No.
Owner Namd-'~ %-c~
Owner Mailing Address'"5-~
Oxvner Property Address
Tax Map No: Section ~ ~D~, Block C2'-b Lot
Please check each that applies: New Construction
Alteration to Existing System
Residential Non-Residential
Received by:
NOTE: LOCATION MAP MUS. T--BE-SUBMITTED ~rITH APPLICATION. (Locate
building and s3~em; give north.m'r~ow and appro~qtuate distance in feet from system to building
m~d closest road_ New construcfion may submit cop~; of survey with 8 CI-II) approval_)
Signamye% f Applicant Date
Z
X < 0 (LUT~5 ~OAP~ ~