HomeMy WebLinkAboutZoumas ELIZABETH A. NEVILLE
TOWN CLERK
REGIST~ OF VITAL STAT[ST[CS
MARRIAGE OFFICER
RECORDS NL~AGEMENT 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
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
JAN 2 0 - ~ TOWN OF SOUTHOLD
TO:
FROM:
DATED: January 20, 2005
Transmitted herewith is a copy of application No.. 3425
Permit submitted by:
Zoumas Contracting
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
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
DISAPPROVE
Comments: ~~
Signature
Dated
ELIZABETH A. NEVH J.E
TOWN CLERK
KEGISTRAR OF VITAL STATISTICS
MARRIAGE 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
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
Application No.3~,~5
Permit No.
Applicant Name
Applicant Mailing Address
Septic Tartly..._~_.or Cesspool.._~
Brief Description of Proposed Construc~on or Alteration
Location of Proposed Construction/Alteration:
Owner Mailins Address: ?.0 [~q~- ~' 6 /
Name and phone number of contact person
Tax Map No: Section "~ O Block '~, Lot "7 /
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH H~'~LTH DEPARTMENT APPROVAL
Si~'%ture
of~t
'Date
Received by:
.,._,,
f FL T~EV_" 34;0
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