HomeMy WebLinkAboutSakarellos, Elizabeth ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORM-&TIO.~i~FFICER
~O: ~ v'¥~}"~-gfx~xCfi'Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
DATED: April 7, 2005
Transmitted herexvith is a copy of application No. 3453
Permit submitted by:
for a Cesspool/Septic Tank Construction
Danny Isla~ P. E.
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 thc 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
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
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.~q ~')
Permit No.
Applicant Name
Applicant Mailing Address
Septic Tank ~'~ or Cesspool
Br/ef Description.of Proposed Construction or Alteration
Location of Proposed Constmctio~Alteration:
Owner of Prope~y: ~Lt~T~
O~er Mailing Address:
Name and phone number of contact person Da.o ~ ~-¢ [4 ' ~-/(~ -~ '~/>' ~ ~
Tax Map No: i/~d~ Section ~ Block- 9- Lot .~
Cross Street 5~tx~ OrWe~ . ,'."
' Silage o£App,ic - ate
,£g
M ,,00,~g-£O N
S.C.T.M.# 1000-33-6-8
** Residence is 200' +- distant
from property line