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Home My WebLink AboutKrudop, Robert ~TJ~A~ETH A. NEVTLL~ TOWN CL~K REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hail, 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 C/or Non-Residential ~ $25 __ Applicant Mailing Address "~ {~ c, 7,, [0~7... Septic Tank or Cesspool ~ Brief Description of Proposed Construction or Alteration Application No,3~1 Permit No. Location o f Proposed Construction/Alteration: Owner of Property: MIL Owner Mailing Address: Owner Property Address: Name and phone number of contact person '-~L~ k-~.c~ Tax Map No: Section c~ Block ~) I Cross Street ~M- t~ NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION, NEW Signatt~re of App,~/' D~tf Received ~y: ~ Lot F£gtilUARY 26, 2001. ~ 10, 200~ ADOED ~O.N. AREA = 12,2~.58 0.281 Nmthmn Tmft Om'win mm l_mmd igurveyor gG2 Roanoke Avenue Rhterhead, New York 11901 ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS I~CARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hail, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax 1631) 765-6145 Telephone ~631) 765-1800 southoldtown.nort hfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: FROM: DATED: February 18, 2005 Transmitted herewith is a copy of application No. Pemlit submitted by: Robert Krudop Southold Town Building Department Linda J. Cooper, Southold Town Clerk's Office 3437 for a Cesspool/Septic Tank ConstrRction 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: J APPROVE DISAPPROVE Comments: Dated