HomeMy WebLinkAboutWhite, Robert ELIZABETH A. NEVH,!,~, -"
TOWN CLElt~
P~GISTRAit OF VITAL STATISTICS
RIARRI. AGE O~FICER
· RECORDS 1ViANAGE1VIlgNT OFFICER
FREEDOM OF INFORMATION OFFICER
TO:
OFFICE OF TH]~ TOWN CI,~,,RK
TOWN OF SOUTHOLD
Southold To~m Building Department
Town Hail, 53095 Main Road
P.O.:Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
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· FROM: Linda J. Cooper, Southold Tovm Clerk's Office
DATED: July 1, 2004
Transmitted herewith is a cop3' of application No. 3342 for a Cesspool/Septic Tank Construction
Permit submitted by:
Stacey Bishop for Robert & Leona White
Please review the appl/cation and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the penuit.
Please complete the form below and return it to me_
Linda J. Cooper
I have rexdewed the application and location map of the project cited above and make the following
recommendations:
·
APPROVE
DISAPPROVE .
Colllments: ~
Dated
ELIZABETH A. N~VII,T ,~..
TOWN CLERK
REGISTHAR OF VITAL STATISTICS
MARRL~GE OFFICER
,~,ECOB. DS MA~AGEMEN~ OFFICER
~EEDOM OF INFORMATION OFFICER
Town Hail, 53095 MEn Roacl
P.O. Box 1179
Southolcl, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD VirASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 ~ or Non-Residential ~ $25 __
Applicant Name ~-~c~V 7g,stq,c~ -- '~O3~r-
ApplicantMailingAddress /~c~ c)^~'-~w~.4/;c-z,.) L-")A~ ~,C'o-x-~-D~,o~o /~'V llC--2-7/
Application No. __
Permit No.
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property:. /{7o/3~&-f- 4 Lr_:o~r~ t,d~ ~r-~-
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person
TaxMapNo: Section /0 ~
Cross Street A4~td tzo.
Block / Lot o~&
NOTE: 'LOCATION MAP I~iUST BE SUBMITTED WITH APPLICATION. NE~V
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Received lJy:
S i~'~( ~oo f~A3~p ~l/c ant
Date
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