HomeMy WebLinkAboutDeMilt, James ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS I~L, kNAGEMENT OFFICER
FREEDOM OF INFORMATI~O~CER
.....
; t~7-. ..... .'u~t~l"~ OFFICE OF THE TOWN CLERK
T C~.._Z,.£? ,.~}' _~gyUittol~T-o~tr~ uilding Depmment
FROM: Linda J. Cooper, Southold Toxvn Clerk's Office
To~vn Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax t631) 765-6145
Telephone (631) 765-1800
southoldtown.nort h fork.net
DATED: May 16, 2005
Cesspool Construction Application
Transmitted herewith is a copy of application No. 3468
Permit submitted by:
for a Cesspool/Septic Tank Construction
James DeMilt at Tuthill Rd
Please reviexv 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:
Dated
ELIZABETH A. NEVILLE '~
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
..Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York ][1971
Fax (631) 765-6145
Telephone (631) 765-1800
sout holdtown.northfork.net
Residential ~ $10 or Non-Residential ~ $25 __
Applicant Name '~ rvn
Applicant Mailing Address
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
Application No. ~q~f
Permit No.
Location of Proposed Construclion/Alteration: -7-u/~,-// P,o/.
Owner of ProperV: '%a e.S
.. .11 _ ~ ..... [' ~1
Owner Mailing Address: ~;:f,, ~,~ .~,----~./ 7~L ~X~.~ ~-
Owner Property Address: 7~'7-~/6C ~?
Name and phone number of contact person ~c~, ~ /~a, rrL/~z
Tax Map No: 10aa Section b~6~ Block ~ 3
Cross Street Z-o~ ~,~ ~ ~ ~ ~
NOTE: LOCATION MAP MUST BE SUBMITTED WITII APPLICATION. NE~r
CONSTRUCTION REQUIRES SURVEY WITIt ItEALTH DEPARTMENT APPROVAL
/~ff~/~a~ture o f Applicant ' Date
Received
Lot --% /
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