HomeMy WebLinkAboutFischer, Dianna ELIZABETH A. NEVILLE
TOWN CLERK
REGISTP~R 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
FROM:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
['own Building Department
Linda J. Cooper, Southold Town Clerk's Office
DATED: April 11, 2005
Transmitted herewith is a copy of application No. 3457
Permit submitted by:
for a Cesspool/Septic Tank Construction
Dianna Fischer
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
Signature
Dated
· ELIZABETH A. NEV~.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
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1300
sout holdtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10
__ or Non-Residential @ $25 __
Application No. ~{q~]
Permit No.
Tax Map No: Section
Cross Street /.~P S'{- _/,4,
Please check each that applies:
3/ mock 7 Lot ttO
New Construction
Alteration to Exi~ing System
Residentialt~ '. Non-Residenti~/l
NOTE: LOCATION MAP MUST BE SUBMITTED W~TH APP(LICAT_!:O_N. (Locate
building and system; give north arrow and approximate distance in feet fromsystcm to building
and closest road. New construction may submit copy of survey with SCI-ID approval.)
Received b~:~¢t~5'
Signature of Applicant
Date