HomeMy WebLinkAboutPike, Beth A. ELIZABETH A. NEVILLE
TOWN CLERK
REGISTR.MR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORI%LATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 1197[
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.nort hfork.net
TO:
FROM:
DATED:
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
November 17, 2004
Transmitted herewith is a copy of application No. 3402 for a Cesspool/Septic Tank Construction
Pemlit submitted by:
Beth A Pike
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.
I_inda J. Cooper
I have reviewed the application and loflation map of the project cited above and make the following
reconm~endations: /
APPROVE
DISAPPROVE
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFPICER
FREEDOM OF INFORM~kTION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldt own.noN:hfork.net
OFFICE OF TIlE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PER~IIT
CESSPOOL or SEPTIC TANK
Residential 6) $10 / or Non-Residential @ $25 __ Application No3JtO ~
Permit No.
Applicant Mailing Address ~tr) ,~
Septic Tank or Cesspool
BricfDescription ofProposed Construction or Alteration ~ '<~F gl4/(:'
Location of Proposed Construction/Alteration:
Owner Mailing Address' ~2~) mX
Name and phone number of contact person
Tax Map No: Section /0¢ Block I Lot
Cross S ect
NOTE: LOCATION MAP MUST BE SUBI~HTTED V~'ITH APPLICATION. NE~r
CONSTRUCTION REQUIRES SURVE¥1WITH HE.a;~TH DEPARTMENT APPROVAL
~/~ Sigffamre of Applicant / Datte
Received I~y: ~y{/~_,,z~
anNaA V /, Ve