HomeMy WebLinkAboutMeriam, Tom ELIZABETH A. NEVILLE
TOWN CLERK
REGISTR.Mt OF VITAL STATISTICS
I~LMR RL~GE OFFICER
RECOHDS i~L~AGEAIENT OFFICER
:FREEDOM OF INFOB~£A_TION OFFICER
OFFICE OF THE TOWN CLERK
TOIVN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.nortl~ork, net
TO: Southold Town Building Department :
FROM: Linda L Cooper, Southold Town Clerk's Office : ..... 77-i ......... ' .:~ .'. .......
DATED: October 8, 2004
Transmitted herewith is a copy of application No. 3383
Penn.it submitted by:
for a Cesspool/Septic Tank Construction
Samuels & Steelman for Tom & Susan Meriam
Please review the application and location map and a&dse 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
Comments: ~..~---~
Signature
Dated
OI~IToC~ TI~ TOWN OF
WN O1~ SOUTIIOLD
~l .rZABE'iH A, NETI! i ~a; TOWN CLEIU~
P.O. BOX i I79
SOUTiiOLD, NEW YOl~li ll~71
~relephone
(63-it). 76~-1800 ' $25.00 - Non-Residential
UTHOLD WASTEWATER DISPOSAL DISTRICT
' ~PPLICATION '-~
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK o~ CESSPOOL
· Application No.
Construction
Alteration
$10.00 - Residential '
Permit No,
Fee $
'APPLICANT NAME:
APPLICANT ADDRESS:
SEPTIC I/// CESSPOOL
DESCRIPTION Of PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ,ALTERATION:'
OWNER OF PROPERTY: ~/'/'~ ~ ~'/-4~3"~/'~/
OWNER MAILING ADDRESS: /~ ~~~
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO.: Section //~ Block // Lot
caoss STaEET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
RECEIVED BY:
J/'l'owl~~ Clerk's Office
/~T~nature of Applicant
J~
HOLE CREE~
RECELVED .~
SUFFOLK COU NT~
HEALTH SERVICES
MAR-q1 A I1: 2h.