HomeMy WebLinkAboutZahra, Richard ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITP~L STATISTICS
MARRIAGE OFFICER
RECORDS ~L~kNAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
X~' ~ ~ :' ;\\bFFICE OF THE TOWN CLERK
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FROM ~ [iRda J. Cooper, Southold Town Clerk's Office
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (63D 765-6145
Telephone (631i 765-1800
sour holdtown.nor th for k.net
DATED: March 25, 2005
Transmitted herewith is a copy of application No. 3447
Permit snbmitted by:
for a Cesspool/Septic Tank Construction
Richard Zahra
Please review the application and location map and advise if the project has received Snffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and retum it to me.
Linda J. Cooper
I have reviewed the application and location map of the project cited above and make the tbllowing
recommendations:
APPROVE f
DISAPPROVE
Comments:
Signature
Dated
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF V/TAL 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 (63.1,) ?.657~800
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
__ or Non-Residential ~ $25
Application No. 3~L{'-]
Permit No.
Applicant Name
Applicant Maihng Address
Septic 'lank- ,~/~r-Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person
Tax Map No: Section
Cross Street
Lot
Signature of App~e~
Date
Received by: I
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION 'REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL