HomeMy WebLinkAboutHolzer, Robert ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
. j ~ RECORDS MAi~AGEMENT OFFICER
· iFREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO:
FKOM:
DATED: October 6, 2004
Transmitted herexvith is a copy of application No.
Permit submitted by:
Stacey Bishop, For Robert ttolzer
Southold Town Building Deparanent
Linda J. Cool~, Southold Town Clerk's Office
3382 for a Cesspool/Septic Tank Construction
Please revie~v the application and location map and advise if the project has received Suffolk County
Health Department approval and if tkis office may issue the permit.
Please complete_ the form below and return it to me.
Linda J. Cooper
I have rexdewed the application and location map of the project cited above and make the following
recommendations: ~,~
APPROVE
DISAPPROVE
Comments:
Dated
MARRIAGE OFFICER
, ' ~, P. ECORDS MANA~/~NT OFFICER
~REEDOM OF I~FOI~d. ATION OFFt~I~
Town ~ 53095 Muln Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southolcltowm nor th~ork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 ~ or Non-Residontial ~ $25 __
Application No.
Permit No_
Appl/cant Mailing Address /~6 r.J.,~7'~/~-~ 0,~, ~'~--~-,o //qV/
Septic Tank or Cesspool ~
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property.
Owner Mailing Address: ]~ --Fo~-~a
.J
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