HomeMy WebLinkAboutGriffin, Michael ELIZABETH A. NEVI~ ,l,~,
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
~bER
,.dt.~i ^~11 i~ OFFICE OF THE TOWN CLERK
! L-- . / Tow or souTHoLI)
TO: ~ Southold Town Building Department
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED: April 8, 2005
Transmitted herewith is a copy of application No. 3455 for a Cesspool/Septic Tank Construction
Permit submitted by:
Michael & Grace Griffin
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 beloxv and return it to me.
Linda J. Cooper
I have revie~ved the application and location map of thc project cited above and make the follo~ving
recommendations: ~
APPROVE
DISAPPROVE
Comments:
OYklCE OF TI.~ ~[OWN CLERI~
TOWN OF ~OUTIIOLI)
[:LiZ~J]I-~I A. NEVi~, TOWN
P.O. ~OX 117~
sO~O~, ~W YORK 11971
Telephone
(5t6) 765-180~
Application
Construction
ALteration
$10.00 - Residential
$Z5,00 - Non-Residen rial
TOWN OF SOUTHOLD
-~OUTHOLD '
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee'~ /O, O~
D~SCR~PTiON O~ PROPOS~D..CO~STRU.C~ION~OR,.,~LZE~,~IbN
LOCATION MAP: Must be attached hereto be¢ore').~ermJt ~a~.'be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:'
OWNER PROPERTY ADDRESS:
TAX MAP NO.: Section ~ Block,.
BUILDING PERMIT NUMBER CROSS REFeReNCE:,
Signa~e of Appl~
RECEIVED
k's Office
DATE: ~ .
4:[[
~ ,, ~ ~ <~ < ~ ~ ~ ~Y ~I~R~~
~// ~ ~ ~ ~ ~ ~ %% 'X~ /~ ~l I~~
II
~ //
.R
· l \
00°2~'16'' ~
,R'IC_.,-HT OF: tNAY
"/8'.q4'
T__ '~