HomeMy WebLinkAboutMealy, Aubrey ELI ETH A. NEVILLE
Z~TT~WN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Ha/l, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
sour holdtown.northfork.net
TO:
FROM:
DATED:
Transmitted herewith is a copy of application No. 3396
Permit submitted by:
LI Permit Service for Aubre¥ & Pricilla Mealy
~ ... ~ ~ OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
November 8, 2004
for a Cesspool/Septic Tank Construction
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 thy project cited above and make the following
recommendations:
APPROVE /
DISAPPROVE
Comments;
Signature
Dated/////~ ~/~
ELIZABETH A. NEVILLE
TOWN CLERK ..
REGISTHAI~ OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFOHMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
To~m Hall, 53095 Main Road
' P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
sout holdtown.northfork.net
Residential ~ $10__ or
Applicant Name/]/~b~FEU
Applicant Mailing Address
Septic Tank ~6r Cesspool
Brief Description of Proposed Construction or Alteration
Non-Residential ~ $25 __ Application No.
Permit No.
~ - }
Location of Proposed
Owner of Property:
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person ~U [(F{L
Tax Map No: Section ~-7 Block
Cross Street ~JOgOOti <} p(j
NOTE:
Lot /
LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEAhTH DEP~t~RTMENT APPROVAL
S!gfiature of At~iicant
Received ky: ~ 'k fio~
(VN~'N~ /
NIDIF BEAUBIN
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