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Home My WebLink AboutProios, John ELIZABETH A. NEVILLE TO~VN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS I~CANAGEMENT OFFICER FREEDOM OF INFORSL-kTION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 1_1971 Fax ~.63].) 765-6145 Telephone ~631) 765-1800 southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD T(~.~ FROM: DATED: Transmitted herewith is a copy of application No. Permit submitted by: Roberts Custom Homes Southold Town ,Building Department Linda J. Cooper, Southold Town Clerk's Office November 17, 2004 3401 for a Cesspool/Septic Tm~k Construction Please review the application and location map and advise if the project bas received Suffolk County Health Department approval and if this office may issue the permit. Please complete tbe fom~ 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 · ELIZABETH A. NEVILLE TOWN CLERK REGISTRAH 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 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERIVIIT CESSPOOL or SEPTIC TANK Residential ~ $10 /or Non-Residential @ $25 __ Permit No. ApplicantNam'e~C,,,"Oe~ Q.~,S ~ Applicant Mailing Address ¢(~3 ~C_)~- '-~'-7 7_.- Septic Tank //o~ Cesspool Brief Des~,fiptior~ f Proposed Construction or Alteration Location of Proposed Constmction/Alteraf~6~: Owner of Prope y: ¥'CSi Application No. NOT[ Owner Mailing Address: Owner Property Address: ~ ~ (..)~<oe5 Name and phone number of contact person ~) ICJ(-~ --l---L)-~q ~ ~-~:~/~ Tax Map No: Section ~ / Block ~ Lot Cross Street (~ O.A./Yk NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITI~ItlEALTH DEPARTMENT APPROVAL Signature of Applicant Received by: . '"