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HomeMy WebLinkAboutBonagura, Barbara ELIZABETH A. NEVILLE TOWN CLERK REGISTKAR 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 $OUTHOLD TO~ FROM: DATED: January 24, 2005 Transmitted herewith is a copy of application No. Permit submitted by: Barbara & Anthony Bonagura Southold Town Building Department Linda J. Cooper, Southold Toxvn Clerk's Office 3426 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 folloxving recommendations: ~ APPROVE DISAPPROVE Commentsl ~ignature Dated REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Tow oF SOUTHOLD ~ /.~gff ISTRICT APPUCATION Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.northfork.net CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential ~ $10 / or Non-Residential ~ $25 __ Septic Tank or Cesspool Brief Description of Proposed Construction or Alteration Application No. Permit No. Location of Proposed Construction/Alteration: Owner of Property: C~: [4~ ~9,~o .AC Owner Mailing Address: Owner Property Address: / Name and phone number of contact person Tax Map No: Section i~ 3 Cross Street ~ II .e_,ff 0-*c~ NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL Received I~ ' ,'~ ] Signature of A~plicant Date Block ~ Lot ti I / .0'-,~: 'NIH 'NIH LU 'N[I~ ,~