HomeMy WebLinkAboutBrady, John & Emily ELIZ~ETH A. NEVILLE
~rOWN CLEP,~
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS 1VIANAGEM~NT OFFICER
FREEDO1Vi OF' INFORM_~TION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown_northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
FROM:
SonthoM Tow'n Building Departmem
Linda J. '~6c~per, Southold Town Clerk's Office
DATED: September 20, 2004
Transmitted herewith is a copy of application No. 3376 for a Cesspool/Septic Tank Construction
Permit submitted by:
John &Emilv Bradv
Please re~?iew the application and location map a~d adxdse if the project has received SuffoLk Cotmty
Health Department approval and if this o£fice may issue the permit.
Please complete the form beloxv and rettmx it to me.
Linda J. Cooper
have reviewed the application and location map of the project cited above and make the following
recotmnendations:
APPROVE J
DISAPPROVE
Comments:
Dated
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTHAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS 1W-A/qAGENIENT OFFICER
· FREEDOM OF INFORMATION OFFICER
Town HaLI~ 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (63t) 765-I$00
southoldtow~.nortkfgrk.net~
OFFICE OF TI-IE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK'
Residential ~, $10
__ or Non-Resident/al ~ $25 __
Application No. -~ ,3 7 ~
Permit No.
Septic Tank t~or Cesspool
Brief Description of Proposed Construction or Alteration
Ide ua ..SePTIc
Location of Proposed Construction/Alteration:
OwnerofProperty: Jc~/-/t~'..~ tzt',7,/~.,y
Owner M~iling Address:/~ ? D/c .w~9.0/'97~/?e m/)--~,o~& M~Y //71.7
Oxvner Property Address:
Name and phone number of contact person
Tax Map No: Seet/on~,~__~7"-r~'_~ Block ~ Lot k{~' 7
NOTE: LOCATION ~ MUST BE SUB~TTED ~TH ~PLICA~ON.
CONSTRUCTION ~Q~S S~VEY %~TH HE~TH DEP~T~ ~PROV~
Received
, ~ofXp~an[ ~ ' Dat~
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