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HomeMy WebLinkAboutZappala, Agatina ToWN CLERK REGISTI~ OF VITAL STATISTICS I~M~RIAGE OFFICER RECORDS MAtqAGEMENT OFFICER FR~EDO~V¥ OF INFOR~L~TION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.nor thfork.net TO: FROM: .J/[~~ ~ ~'~ OFFICE OF THE TOWN CLERK ToWN OF SOUTHOLD Southold Town Building Department Linda J. Cooper, Southold Town Clerk's Office DATED: January 12, 2005 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 3421 Permit submitted by: for a Cesspool/Septic Tank Construction Please review the application and location map and advise if this office may issue the permit. Please complete the form below and return it to me. Thank you. I have reviewed the application and location map of the project cited above and make the following recommendations: / APPROVE DISAPPROVE Comments: Signature Dated ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFOi~IATION 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 PERMIT CESSPOOL or SEPTIC TANK Residential ~ $10'~or Non-Residential ~ $25 __ Applicant Narne ~ f~-/~-r i'AJ f) ~ ~)t~ ~1 Applicant Mailing Address /--/~).~] ~-~-~12t'C_.ff-.-'~ Application No. ~c/~/ Permit No. Septic Tank or Cesspool Brief Description of Proposed Construction or Alteration Location of Proposed Construction/Alteration: Owner of Property: El f~ TJ~r~ "2~ 1~ P ~ ~ Owner Mailing Address: 24~q Owner Property Address: ,O,ST ' Name and phone number of contact person Tax Map No: Section 3 L) Block ,~) Lot / "~ I Cross Street NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL Signature of Applicant Date Received I~y: _.//ta,,~' ,_at~ nl zo