HomeMy WebLinkAboutRoberts Custom Homes ELIZABETH A. NEVILLE
TOWN CLERK
REGISTR.MR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Sou[hold, New York 1197l
Fax (631) 765-6]_~5
Telephone (631) 765-1800
sou[ holdtown.nort hforl~ne~'
,,.¢: 6 2004-
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO:
FROM:
DATED:
Transmitted herewith is a copy of application No.
Penni[ submitted by:
Robert's Custom Homes
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
November 16, 2004
3400 for a Cesspool/Septic Tank Construction
Please review the appliqation 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 ~Sroject cited above and make the following
reconmlendations:
APPROVE ~
DISAPPROVE
ELIZABETH A. NEV~
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFOB. M~TION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
$outhold, 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 PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $ l 0 v'/or Non-Residential @ $25 __
Application No.~_~ Ct~
Permit No.
Applicant Name ~<t~%C~ ' ff-~L~ 6 4~'~'~
Applicant Mailing Address ¢~ i~r_.)~f 37 ~-
Septic T~ or Cesspool
Brief Description of Propose~ Consmction or Alteration
~cation of Proposed Constmctio~Alteration:
Owner Mailing Address: ~ ~ ~ c,'/ ~ ~
ddress:
Name and phone number of contact person ~[
Tax Map No: Section I ~ Block
Cross Street ~ ~t ,~ ~C~ ~0~
NOTE: LOCATION M~ MUST BE SUBMITTED WITH ~PLICATION. NEW
CONSTRUCTION ~QUI~S SURVEY WlT~TH DEP~TMENT ~PROV~
~i~ature of Applic~t Date