HomeMy WebLinkAboutLeighton, Robert ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATIST/CS
MARRIAGE OFFICER
RECORDS M.~MNAGEMENT OFFICER
FREEDOM OF INFORS,L-XTION OFF1CER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fox (631) 765-6145
Telephone (631 ) 765-1800
southoldtawn.northfork.net
TO:
FROM:
DATED: November 10, 2004
Transmitted herewith is a copy of application No.
Permit submitted by:
Catherine Mesiano for Robert Leighton
OFFICE OF THE TOWN CLERK
Tow ·
\
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
3397 for a Cesspool/Septic Tank Construction
Please review the application and location map and advise if the project has received Suffolk County
ttealth Department approval and if this office may issue the permit.
Please complete the fom~ below and return it to me.
Linda J. Cooper
I have reviewed the application and location n-tap of the project cited above and make the following
recommendations: ~
APPROVE
DIS.~PPROVE
Signature
OFFICE OF ~ TOWN CLERK
TOWN OF SOUTHOLD
ELiZABETH &. NEVILLE, TOWN CLERK
pO. BOX 1179
$OUq~IOLD, NEW YORK 11971
Telephone
(516} 765-1801
TOWN OF SOUTHOLD
Application No.
Construction
Alteration
$10.00 -Residential ~/
$25.00 - Non-Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
,- DATE
APPL,CAN* ADDRESS: m,'t
SEPTIC /CESSPOOL /
DESCRIPTION OF PRQPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued,
LOCATION OF PROPOSED CONST~-RUCTIONz) L7 / ~- '/2/~A TERATION: OWNER OF PROPERTY:
OWNER ~,~,.~
TAX MAP NO.: Section
-CROSS STREET: ~., ~
BUILDING PERMIT NUMBER CROSS REFERENCE:
RECEIVED B Y :~t~J
DATE: t\/\~/k~ Town Clerk's Office
Signature of Applicant
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