HomeMy WebLinkAboutEccles, Thomas ELIZABETH A. NEVILLE
~OWN CLERK
REGISTtC~kR OF 'vITAL STATISTICS
I~L~RRIAGE OFFICER
~Ecoavs ~_~3~ .E~L~E~. ~3F~C E R
~:4 .....~r 'i:~°~vn Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldt own.northfork.net
OFFICE OF TI-HE TOWN CLERK
TOWN OF SOUTHOLD
TO:
Southold Toxxm Building Department
FROM:
Linda J. Cooper, Southold To~xm Clerk's Office
DATED: August 25, 2004
Transmitted herewith is a cop), of application No. 3369
Permit submitted by:
for a CesspooFSeptic Tank Construction
Thomas & Betty Lou Eccles
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and retrain it to me.
Linda J. Cooper
I have reviewed the application and location map of the project cited above and make the follo~xSng
recommendations: ~
APPROVE
DISAPPROVE
Commen~s:
Dated
ELIZABETH A. NEVILLE
TOWN CLERK
i~EGISTRAH OF V1TAL STATi§TICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICEE
FREEDOM OF r~FORMATION OFFICER
OFFICE OF THE TOWN CLERK · .- TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or AI~TERATION PERI~HT
CESSPOOL or .SEPTIC TANK
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (6'31) 765-1800
southoldto wn.nor~h fork.not
Residential ~ $10~ or Non-Residential ~ $25 __
Application No. 3 ~ ~7
Permit No.
/
Received 6y: ~
Ownm Property Address: LDo(~- t60
N~e ~d phone nmber of contact person
T~ Map No: 8~fion 1 ~ Block
NO~: LOCATION ~ ~ST BE S~TED ~TH ~PLICA~ON. ~W
,CONSTRUCTION ~Q~S S~Y ~H ~TH DEP~T~NT ~PROV~
~i~a=e[o f Ap~c~t
__/