HomeMy WebLinkAboutYudelson, Bruse ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
REC~DE .~&~.-~.L~_C_~_~_~.XTT OFFICEt~
I
J____._~_;,. ] TOWN OF SOUTHOLD
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~ TO,W,N OF SO, JT~
TO:
FROM:
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
DATED: April 14, 2005
Cesspool Construction Application
Transmitted herewith is a copy of application No.
Permit submitted by:
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
3458 for a Cesspool/Septic Tank Construction
Bruse and Patti Yudelson by Liso Construction
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me. Thank you.
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE /
DISAPPROVE
Comments:
ELIZABETH A. NEV~,T,E
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARHIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICEH
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 __
Applicant Name [-~ $o C.~,I-t~ t.. CLOP- P'.
Application No. '?/"/~0~'~
Permit No.
Applicant Mailing Address?-
Septic Ta~ f or Cesspool '~
Brief Description of Proposed Construction or Alteration
Location of Proposed
Owner of Property:
Owner Mailing Address: =,~
Owner Property Address:
ll7g. o
Name and phone number of contact person ~ ~'~.~ '~ ~- ~' ~ a
Tax Map No:/~'~g~ Section /,.5-' Block O d Lot O
Cross Street / ~tra~ ~- r~ c ~.a- ~ L~
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Received 6y:
!
Signature of Applicant ~
' Date
THREE WATERS LANE
LOT
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