HomeMy WebLinkAboutGrattan, Timothy · ELIZABETH A. N~VILLE
TOWN CLEHI(
REGISTtka~ OF 'VITAL STATISTICS
iViAHHIAGE, OFFICER
RECORDS ~LAlqAGEMENT OFFICER
,_~REEDOi~ OF INFOR2/LkTION OFFICER
;::.. SrP l 32004
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 76.5-1800
southoldtowa,nor tb~ork_net
S outhold~ Toxvn Bufldiug D ep artment
FROM: Linda J. Cooper, Southold Tow-a Clerk's Office
DATED: Septcquber 10, 2004
Transmitted herex~dth is a copy of application No. 3373 for a Cesspool/Septic Tank Construction
Permit submitted by:
Timothy Grattan
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 remm it to me.
.Lh~da J. Cooper
I have reviewed the application~and location map of the project cited above and make the following
recommendations: ~
APPROVE
DISAPPROVE
Comments: ~
Si~ature
Dated ' "
TOWN
REGISTRAR OF v££AL STATISTICS
MA/~IAGE OFFICER
~F_~ORDS MANA ~/~T OFFICEE
FREEDOM OF INFORMATIO~I OFFICER
Town Hall~ 53095 M-~ Road
P.O. Box 1179
S~u~hal~ New York 11971
Fa~ (631) 765-6145
Te~ephon~ (631) 765-1800
southoI~m~nor th~rl~ne~
OFFICE OF THE TOWN CT,gRK
TOV~ OF SOUTI-IOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 ~ or Non-Residential ~ $25
Applicant Name ~/~crrl4~'
Applicant Mailing Address ~d /~5 ~'~
peo on no. 33
Permit No.
Septic Tank or Cesspool.__
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Pwpert-y:
Owner Mailing Address: ~_? C_.~q~q,,~tf~:.~,,,3 ,,~r~..
Name and phone number of conta~t'pemon- '/'7~/,~ ~'~,~
Tax Map
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WlTIt I:I'E. ALTIt DEPARTMENT APPROVAL