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Home My WebLink AboutRoberts Custom Homes 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 1631) 765-6145 Telephone (631~ 765-1800 southoldtown.northfork.net i~ ..r-.~d.., T ,wn Building Department Linda J. Cooper, Southold To~vn Clerk's OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Office DATED: April l, 2005 Transmitted herewith is a copy of application No. 3450 Permit submitted by: for a Cesspool/Septic Tank Construction Robert's Custom Homes 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: APPROVE / DISAPPROVE Comments: Signature · ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS NLM:tRIAGE 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 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 Apphcant Name'~--o ~.~c Applicant Ix{ailing Address Application No. ~q 5~) Permit No. Septic Tank ~. or Cesspool Brief Description of Proposed Construction or Alteration Location of Proposed Constmctio~Alteration: Owner Mailing Address: ~0 Owner Property Address: Name and phone number of contact person Tax Map No: I O0 0 Section Cross Street NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY V~3[T~L~EALTH DEPARTMENT APPROVAL ,- ~ Signature of Applicant Date Received bv'