HomeMy WebLinkAboutGreenport Heights Development ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
~': ¢.. ¢~ _.':, "--~'"--'~1'~ I~ ' ~ OFFICE OF THE TOWN CLERK
....... or SouTuOLI)
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q~lO: ~-'~-2' :' -~[d, 7°wn~Building Department
F~m~.. Unda J. Cooper, Southold Town Clerk's Office
DATED: May 17, 2005
Transmitted herewith is a copy of application No. 3466
Permit submitted by:
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldt own.nor th for k.net
for a Cesspool/Septic Tank Construction
Greenport Heights Development LLC Michael Domino
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 belo~v 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
Comments:
Signature
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF 1NFOR/VI~TION OFFICEH
' APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 ~or Non-Residential @ $25 /
Applicant Mailing Address ~6~.~ 7/'- ~ t,,/-~
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
Application No., 3q~
Permit No.
,,,f ?/
Septic Tank / or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
OwnerofProperty: ~,-~r..te~pO'4 ~ [~,
Owner Mailing Address: ~.al~-xZ, l-
Owner Property Address:
Name and phone number of contact person ~ ~
Tax Map No: t, Ol.~ Section ~r~ Block o ~ Lot ~. /
CrossStreet ~_oore.¢ J~.4~o.
//
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Received by:
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