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
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