HomeMy WebLinkAboutKapassakis, Georgia ELIZABETH A. NEVILLE
TOWN CLERK --
REGISTRAR OF ~riTAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
- ~Town HaLl, 53095 Main Ro~d
P.O. Box 117~
Sou~hold, New York 11971
Fax (631) 765-614~5
Telephone (631) 765-1800
southold~ow~.northfork.net
TO:
FROM~
OFFICE OF TH]~ TOWN CLERK
TOWN OF SOUTHOLD
Southold T-owruBuildJng Department
Cooper, Southold Town Clerk's Oflice
DATED: June 25, 2004
Transmitted herewith is a copy of application No. 3340
Permit sublrdtted by:
for a Cesspool/Septic Tank Construction
Suffolk Environmental Consultin~o (for Georgia Kaoassakis)
Please review the application and location map and adxdse if the project has received Suffolk County
Health Department approval and 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 m~d location map of the project cited above and make the following
recomn-~endations: ~
APPROVE
DISAPPROVE
Dated
ELIZABETH A. NEVII,L~,
TOWN CLERK
REGISTRAR OF VITAL STATISTIC~
MARRIAGE OFFICER
HECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 76§-6145
Telephone (6~1) 765-1800
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential@S10 X or Non-Residential@S25__ Application No. ~'~L0b
Permit No.
Septic Tank ,'~ or Cesspool
Brief Description of Proposed Construct. ion or Alteration
Location of Proposed Construction/Alteration:
Owner Mailing Address: ~a
Owner Property Address:
· Name and phone number of contact person
Tax Map No: [000 Section Z~
Block ~ Lot q~
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Received I~y: ~'~~5~[
Signature of Applicant
Date
,g'O