HomeMy WebLinkAboutKraus, Emil Allen ELIZABETH A. NEVILLE
TOWN CLERK
HEGISTHAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.nor t hfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO:
Southold Town Building Department
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED: October 21, 2004
Transmitted herewith is a copy of application No. 3387
Permit submitted by:
for a Cesspool/Septic Tank Construction
Emil Allen Kraus
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 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
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 ~ or Non-Residential @ $25 __
Applicant Name ~'vv~ I'~. ~
Application No. /~
Permit No.
Applicant Mailing Address
Septic Tank or Cesspool ~
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
/~~ ~//.Signature of Applican~ '
Received
l ~, '~ l . '7.,o o ?
Date
Owner M~iling Address: A' 7
N~e~dphonen~b~of~nmtp~on~,~ 5~g ~a~ 'tO'bzq-~)~$
T~MapNo: S~fion ~ Block ~ ~t 20.~*ZO.qU~,~/
~0~: LOCATION ~ ~ST BE 8~D ~ ~PLICA~ON. ~W
CONS~U~ON ~Q~S S~Y ~ ~TH DEP~~ ~PROV~
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~UFFOLK
, OF I'E~ALTFI ~ERVIC'E~
APPROVED,
FOR MAX~IUM O~
EXPOs TEREE Y~ARS FROM DAT~ OF-APPROVAL
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