HomeMy WebLinkAboutErickson, Christopher & Rachel REGISTItAR OF VITAL STATISTICS
iVIABAgJ~GE OFFICER
RECORDS MANAC. EAIENT OFFICER
FREEDOM'OF INFORMATION OFFIo~t~
OFFICE'OF TI:~. TOWN CI,ERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FI~0M: Linda J~ Cooper, Southold Town Clerk's Office
DATED: July 9, 2004
Town Hall, 53095 Main Road
P.O. Box 1179
· Southold, New York 11971
Fax (631) 765-614-5
Telephone (631) 765-1800
s outholdtown.nor thfork, net
Transmitted herewith is a copy of application No_ 3344
Permit submitted bT.
for a Cesspool/Septic Tank Construction
Ample Contracting Inc
Please review the apphcation and location map and advise if the project has received Suffolk County
[-leakh Department approval and if this office may issue the permit_
Please complete the form below and return it to mc_
Linda J_ Cooper
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE /
DIS APPROVE
ComlTleuts: ~
Signature
Dated
,7-.
~rLTZ~BETH ,a~ NEVILLE
TOWN CLEI~K
P~GISTRAR OF VITAL STATISTICS
IvlARRIAGE OFFICER
. RECORDSM_a~IAGEMENT OFFICER
'FREEDOM OF INrFOtLMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
SouLhold. New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southold~own.norflaforl~ne~
OFFICE OF TH~ TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
/
Residential ~ $10 /or Non-Residential ~ $25 __
Application No~('~(
Permit No_
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURyEY WITH m%~LTH DEPARTMENT. ,~, PROVAL
~/~ Signfl~re of Applicant ~Date
Recdved gT. ~~
Applicant Mail/ng Addr~s_ Cc> ~ '<~ ~ ~-~ ~
Septic Tank~/ or Cesspool f
Brief DescnpUo'~ of Proposed~_~tmction 5r Altetction
Location of Proposed Construction/Alteration:
Owner Mailing Address: ~'~2> ~-~c>--Z/ ~% ~_
,.,.~
Name and phone ntLmb= of contact person
No: Seotio_. t e-7
NOW ,Ir FORta~y
KENNETH LEE~$
/
S 3~.02o12.E
220.93,
(z4.5~ ffHITE EAGLE DRIVE
DV~.LL ~Jeuc W4TE~
~LQTE: LOCATION OF WATER M.NNS
NqD AI~JOINE]~S WATER SUPPLY BY
OTHERS ,NqD ARE NOT GUARNNTEED.
CERTIFIED ONLY TO:
JOB No. 04-231
SURVEYED FOR CHRIS
LOT NUMBER '1~.
sm JATO.
FILED MAP No. 7770 · ~..TE
TAX MAP No_(EEF Ol~Y) 1000--127--g-18 DISK 2004
HAROLD F. TRANCHON JR. P.C.
)_,AND SUI~/~OR
,.,.-~ P,O. BOX 616
?/ · ,//~-.--~" / !~1 ,e~ wAOiNS RIVEt~-~~OR RO. WAOiNe, RIVER.
F~ r , ?~.--~?.~--~. - I N~ YORK, 11792
/ N.Y, Lie. No. 04aag2'l 6Jl-92g-4695
HAROLD F. T~NCHON JR. PENN. LiC. No. 2t~-E