HomeMy WebLinkAboutRodriquez, Roy ELIZABETH A.
TOWN CLERK
REGISTRAR OF ~riTAL STATISTICS
MARRIAGE OFFICER
RECORDS iViAIqAGEMJ~NT OFFICER
FItEEDOM OF II%!FORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
i :: .~ .... :. ~ - ,L -:' .. ' OFFICE OF THE TOWN CI,F, RK
: .~ :. ': TOWN OF SOUTHOLD
TOf--' ::['~i :~i'-~..-0':a..~.~..r[ To,~'n Building Departmem '
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 14, 2004
Transmitted herewith is a copy of application No. 3347
Permit submitted by:
for a Cesspool/Septic Tank Construction
Roy Rodriguez
Please review the application and location map and advise if the project has received Suffolk Cotmty
Health Department_approval mad 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 thc project cited above and make the following
recommendations:
APPROVE ~
DISAPPROVE
Comments:
Signature
Dated
O~lC~ OF TI~ TOWN
TOWN O1~ SOUTIIOLD
~ r~ABh-rlt k NI~Vn I ~. TOWN I:I.ERK
P.O. BOX i m79
Telephone
(63-~) 755-1800
Application N o. ~_~._..~
Construction
Alteration
$10.00 - Residential /
$25.00 - Non-Residential
TOWN OF SOUTHOLD
5OUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
fo r
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
ATE
'
APPLICANT NAME:
~mc~i ~s~: ~7~ ~ll~t ~. ~ ..
DEScRIPTIoN OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ,ALTERATION':' · OWNER OF PROPERTY: l;~.D~l, ']~:~l~c/~-~_.~
OWNER MAILING ADDRESS: ~/-~_~ ~ ~'~r,_ ~. ~+
OWNEE PROPERTY ADDRESS: ~ ~'l( ~&~Dr.
TELEPHONE NUMBER OF CONTACT PERSON: ~m~ ~W~
TAX MAP NO.: Section I~ Block ~ Lot
BUILDING PERMIT NUMBER CROSS REFERENCE:
· -." ~nature of Applicant
/ To~nl;lerk's Office
DATE: .
?R,O?OSED 5EFTIC 5YDTEM DE'FAIL
DATA
LOT 6.21
PR.~PAP-~D JAN. 20, 200,4
P-,,ODP-.IGU EZ
- 05/21/04
PAl P-,WEATffl ER-bROWN
D, ESIGN A550CIATES,INC.
205 BAY AVENUE
GREEN?OR,T, N,Y. 11944
G31-477-9752 (Fax) G31-477-0973
(VACANT) % : 5U~,pIW~lq~ - ,~,
"~ILL CR,~.GT ESTATI~,. DEC'DON I" ,
(VACAN~ LOT/' '