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HomeMy WebLinkAboutReiersen, Eleanor ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORi~L&TION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.nort hfork.net i, a ! [i OffiCE OF THE TOWN CLERK TO: -"~w~ w Building Department FROM: Linda J. Cooper, Southold Tox~m Clerk's Office DATED: Febnlary 28, 2005 Transmitted herewith is a cop5' of application No. 3442 Pemfit subnfitted by: for a Cesspool/Septic Tank Construction Eleanor Reiersen Please review the application and location map and advise if the project has received Suffolk Couuty Health Department approval and if this office may issue the permit. Please complete the foml 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 ~ DIS:APPROVE Comments: Signature Dated ELIZABETH A. NEVILLE -- TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECO~RDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER ..Town Hall, 53095 Main Road P.O. Box 1179 Southold, Ne~v 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 i/ or Non-Residential ~ $25 __ Permit No. Septic Tank or Cesspool B"efDeso"ption of Propos~a Co~uctio. or ~te~.on Location of Proposed Owner Mailing Address: Owner Properly Address: Name and phone number of contact person T~x Map No: I~ 00 S~tion ©%~, 0 Cross Street ~V~ ~k } ~?'0~\1~ P-.W Block 0%` 00 Lot 030,00 NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SUR~ALTH DEPARTMENT APPROVAL ~-~d) ~fAppliean~J ' l~'te