HomeMy WebLinkAboutMoglia, John 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 (6311 765-1800
southoldto~vn.northfork.net
tUi]i APR2 §201
FROM:
DATED: April 25, 2005
RE:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Building Department
Linda J. Cooper, Southold Town Clerk's Office
Cesspool Construction Application
Transmitted herexvith is a copy of application No.
Permit submitted by:
John Mo[Ilia
3462 for a Cesspool/Septic Tank 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 folloxving
recommendations: ~
APPROVE
DISAPPROVE
Comments:
Dated
ELIZABETH A. NEVIIJ,F,
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFOPQVIATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Town Hall. 53095 Main Road
?.0. Box 1179
Soul, hold, New York ][1971
Fax (631) 765-6145
Telephone (631) 765-1800
southo]dtown.northfork.net
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 *'or
Applicant Name ~o3/n/
Applicant Mailing Address
Non-Residential ~ $25 __
Application No.'~ q ~' ~
Permit No.
/
Septic Tank or Cesspool
B.e Oe c.pUon o opos. o uc.on or te tion /5, o
Location of Proposed Constmction/Alteratil~n:
Owner of Property:
Owner Ivhfi ling Address:
Owner Property Address
Name and phone number of contact person
Tax Map No: Section
Cross Street .~'~y t/,
/
Block O/ Lot /'7
NOTE: LOCATION MAP MUST BE S,~rBMITTED WITH APPLICATION. NEW
CONStRUCTiON ~0Vn~S SURVEY )~]r~;m~aJr¢oEe~m~m AP~aOVaL
Si~a~ Appfic~ Date
R~eiv~ 6y: ~ ~