HomeMy WebLinkAboutGendot Homes ~ETH A.
TOWN CLERK
HEGI-~TRAR OF I/,ITAL ~YATISTiC.q
MARRIAGE OFFICER
RECOILDS MAI~'AGEME. NT OFFICFR
F2E'EDOM OF Ilq~OI~MATIOI~' OFFIC. F2~,
:; ~ [" ' ' OI~ICE OF 'I'I~'TOWN CL~RK
.,i~. '"'. ,. ]~;i!.~i TOWN OF SOUTHOLD
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FROM: Linda .l. Cooper, SouthoM Town Cl~rk'.s Office
Town Hall, 53095 Main Road
P,O, ~ox 1179
Southold, New York 11971
Fax (631) 765-E145
Telephone (6.91)'7~-1800
aOUth _~ldtown.northforl, net
DATED: March 14, 2005
Transmitted hel:w/th is a copy of application No. 3443 for a CesspooYSept/c Tank Cor~truction
Permit submitted by:
Gendo~: ~gme~ In~.
Please review th~ ~plica~/on and ]o;ation map and advi~e if thc project ha~ r~c~ived Suffolk Count),
Health D~pa~rn~at approval and if thi~ o/rice may issue the permit.
Plcasc complete thc form bclow and tatum it to me.
L/nda ~'. Cooper
have mvicw~d the application and location map ofth~ project cited abovc and make thc follow/rig
recommcndations: j~
APPROVE ..
DISAPPROVB
Dated
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Er.I~.~BETH A. NE~.I.E
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
S~uthold, New York 11971
Fsx (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 V/ or Non-Residential ~ $25 __
Apphcant Name ~d~
Applicant Maihn§ Address
Soptic T/~nk"f/ or CesspOol
Brief Description of Proposed Construction or Alteration
Application No3 [~[~
Permit No.
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person
TaxMapNo: /c.L,~ Section "7~-%
Cross Street C~c~/~?/r-/~ ~
Block -~ Lot ~/O 2 'z-
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WIT2~I HEAL.T~ DEPARTMENT APPROVAL
/
~/q Signature of Ap~p~anr~ ' Dae
Received
6y: