HomeMy WebLinkAboutPerino, Joseph 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
sour holdtown.nor th fork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO:
FROM:
DATED: February 23, 2005
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No.
Perufit submitted by:
Joseph and Letitia Perino
Southold Toxvn Building Department
Linda J. Cooper, Southold To~m Clerk's Office
2 3
3439 for a Cesspool/Septic Tank Construction
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
Dated
ELIZABETH A.
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARH. IAGE OFFICER
RECORI~ MANAGEMENT OFFICER
FRae. DOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. !t~ 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown~or thfork.net
OFFICE OF TH]g TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10_~ or Non-Residential ~ $25 __
Applicant Name ...f o St~-P/t~ ~/Z~ dp/c)
Applicant Mailing Address -2~- ~ 0
ff. X.
Septic Tank or Cesspool ~
Application No.-.~
Permit No.
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner Property Address: / / ,~, 0 /-//'~'~a ~
Tax Map No: Section / O .3'. 0 0 BlocktgO/_O0 Lot
Cross Street /)~ 6t {~
NOTE: LOCATION MAP MUST BE SUSMrrrEO WITR APPLICATION. NEW
CONSTRUCTION REQUIRES SURVE~Y WII'H MEAI.TH DEPARTMENT APPROVAL
S~f~ture o{~Applicant Date
_7'