Loading...
HomeMy WebLinkAboutAdams, Estate of ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATIST[CS MARRIAGE OFFICER RECORDS MANAGEMENT O~FFICER rR~E~O~ or mrORM~N Or~,C~R C~ ~?' "~ \.:¢¢: offiCE or *US TOWN CLERK \!, ~' ~- ~ '~'~ '~ TOWN OF SOUTHOLD T~ X . SOuthold Tmvn Building Depament Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.nor thfork.net FROM:' Linda J. Cooper, Sou[hold Town Clerk's Office DATED: May 3, 2005 Cesspool Construction Application Transmitted herewith is a copy of application No. 3464 Permit submitted by: for a Cesspool/Septic Tank Construction JLH Associates LLC for Estate of Adams 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: 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 @ $ l 0 __ or Non-Residential @ $25 __ Application No. 'ff~/~' Permit No. Applicant Name ~-'~ {.- ~ Applicant Mailing Address Septic Tank or Cesspool Brief Description of Proposed Construction or Alteration_ Location of Proposed Construction/Alteration: Owner of Property: ~'.4fU OwnermailingAddress: % ~t~tc Vt./[C_~I([-[A.~/ 655 C_~, Owner Prope~ Address: Nme and phone number of contact person Tax Map No: Section Cross Street ~S~ ~OffG NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION ~QUI~S SURVEY ~TH ~TH DEP~TMENT APPROV~ ~ o?Applicant F ~ate Received by: "