HomeMy WebLinkAboutJones, Alexandra · ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hail, 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
TO:
FROM:
DATED: December 3, 2004
Transmitted herewith is a copy of application No.
Permit submitted by:
Alexandra Jones
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
3404 for a Cesspool/Septic Tank Construction
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.
Linda J. Cooper
I have reviewed the application and location map of the project cited above and make the following
recommendations: ~
APPROVE
Comments:
DISAPPROVE
Signature
Dated
'ELIZABETH A. NEVIL!.~
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Term Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 755-6145
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 ~ $10/or Non-Residential @ $25 __
Applicant Name
Applicant Mailing Address
·
Septic Tank / or Cesspool
Brief Description of Proposed Construction or Alteration
Application No. 9'O {{~
Permit No.
Location of Proposed Construction/Altera~ll~n:
Owner of Property: ~~. ~.R <:~:~0~x~. ,
Owner Property Address: / t~ ~C~- ~? _~/~9 .. l~/ ~ Off)fi} ~T ~)~
Name and phone number Of contact person 4L4~t~O~f'~ ~
Tax Map No: ,/tg~ Section ~ ~ Block t~7 Lot
Cross Street ~-~Ortg//l,~' /-~t'de Or` GV..¢ ~r'! I/~
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
Received IJy: [ O W° ~t ~ ~ -
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