HomeMy WebLinkAboutTravlos, John REGISTRAR OF VITAL STATISTICS
i~-RRLAGE OFFICER
KECOP, DS MANAGE~ OFFICEi~
FREEDOM OF INFORMATION OFFICER
Town H~/~, 53095 Ma/n Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.norflxfork.net
TO:
OFFICE OF THE TOWN CLERK
~'3~ 9. \ %~ TOWN OF SOUTHOLD
Sonthold'Toxqm Building Department
FROM:· Linda J. Cooper, Southold Town Clerk's Office
DATED: June 21, 2004
Transm/tted herewith is a copy of application No. 3337
Perrait submitted by:
for a Cesspool/Septic Tank Construction
John Travlos
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 and location map of the project cited above and make the following
recommendations:
.
APPROVE
DISAPPROVE
Con'mlents: ~
N
Signature
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTKAR OF Vi~AL STATISTICS
..... ~,~RRIA(~E OFFICER
RECORDS lVLa. NAGEI~ENT OFFICER
FREEDOM OF FNFOi{M-kTION OFFICER
OFFICE OF' THE TOVgN CLERK
TO%VN OF SOUTHOLD
SOUTHOLD W.4STEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC Tz&NK
Town Hail, 53095 Main Road
P O. Box 1179
Southold, New York 11971
Fax (631) ~65.-6145
Telephone (631) 765-1800
southoldtown.nortkfork.net
Residential @ $10
__ or Non-Residential @ $25 __
Application No. 333 ?
Permit No.
Location of Proposed Construction/Alteration:
Owner of Property: ~-o ~ ~o -"/-~A V ~-o $
Owner Mailing Address:
Owner Property Address: ¢5" ~ocg: Cove-
Name and phone number of contact person '~o t'~ to "FrOg w.o~q
TaxMapNo: 10o9, Section 0.~Jg,*o Block 0~.oo Lot
CrossS eet
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEP_XRTMENT APPROVAL
S-{/gnature of Applicant Date
Received by: (~ - L,J~~ '
.®