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Home My WebLink AboutMohr, Robert ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR 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.northfork.net TO: FROM: DATED: November 1, 2004 Transmitted herewith is a copy of application No. Permit submitted by: OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Southold Town Building Department Linda J. Cooper, Southold Town Clerk's Office 3392 for a Cesspool/Septic Tank Construction Robert T. Mohr 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 ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York [1971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $10 v/ or Non-Residential ~ $25__ Application No. ~ ~Sq 2.~ Permit No. Applicant Name '~e&~ ~' ~/~o~-..~ Applicant Mailing Address ,-~--Stff-OJ,~_ .t/~ff~_.r Septic Tank or Cesspool~" Brief Description of Proposed Construction or Alteration Location of Proposed Construction/Alteration: Owner of Property: '"~o~to~T' Owner Mailing Address: ~q~-/.x./,'~,~ t~ Owner Property Address: /~,9.~ /~]~,~,~0 Name and phone number of contact person Tax Map No~'ooo Section ~7~?-' Block Cross Street NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL Signature of Applicant Date Received by: %_ ~./(J,~_/(.,"~' .z 6 .0