HomeMy WebLinkAboutLawrence, Robert & Kathy ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
i~.RR IAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORlX/L, kTION OFFICER
OFFICE OF TIlE TOWN CLERK
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax 1631) 765-6145
TeIephone (631) 765-1800
sour holdtox~;n.nor t~fork.net
. TO:
FROM:
DATED: November 15, 2004
Transmitted herewith is a copy of application No.
Permit submitted by:
Dou~ McGahan for Lawrence
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
3398 for a Cesspool/Septic Taifi~ Construction
Please reviexv the application and location map and advise if the project has received Suflblk County
Health Depanment.qpproval 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 project cited above and make the following
recommendations: ~
APPROVE
DISAPPROVE
Signatnre /
Dated~t/'/'
ELIZABETH A. I~EVILLE
TOWN CLERK
REGISTRAR OF VITAL STATIS~IC'S
M_A_~RIAGE 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
sour holdtown.nort h fork.net
Residential ~ $10
Applicant Name
Applicant Mailing Address
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
r Non-Residential @ $25 __
Application No.
Pemfit No.
Septic Tank c/or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person
Tax Map No: Section
Cross Street ~o ~,~ (.~ ~ ,5
Block ~,0~ Lot O~
NOTE: LOCATION MAP MUST BE SUBMITTED rWITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HE~D~PARTMENT APPROVAL
Received
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