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Home My WebLink AboutPederson, James ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR 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: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: February 9, 2005 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 3434 for a Cesspool/Septic Tank Construction Permit submitted by: Itugo A. Cano for James & Deborah Pederson 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 DateT~l-/O ~///~'-%-''~ ELIZABETH A. NEVILLE · ~ TOWN CLERK REGISTP~AR 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 SoLrrHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential ~ $10 __ or Non-Residential ~ $25 __ Applicant Name Applicant Mailing Address ~ Septic Tank v/or Cesspool Application No. x~ Y~ ff Permit No. Brief Description of Proposed Construction or Alteration ~J.Q~ J ~'~k~'~ CL.)C..3~ Location of Proposed Construction/Alteration: Owner of trophy: e%ovr,. Owner Mailing Address: ~\ ~f~f~ CAfC~ Owner Property Address: ~,0~ 6W~el,)~j Name and phone number of contact person Tax Map No: Section C9\%. 00 Cross Street DO~'¢ ~0.~X_ h~-',q 0_~ NOTE: LOCATION MAP MUST BE S~}B~D WITH APPLICATION. NEW ¢~a~r~ of Applicant ti Date