HomeMy WebLinkAboutDeMilt, James (2) ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER -~
RECORDS I~LM'4AG.EMEN'r O~FICER
'2.))f g~ X U~ ; ~OFFICEOFTHETO~CLE~
YO: ~- Southold Town Building Dep~ment
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone ~ 631 ) 765- I800
sour ho|dtown.nort hfork.net
FROIVI: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 16, 2005
Cesspool Construction Application
Transmitted herewith is a copy of application No. 3467
Permit submitted by:
for a Cesspool/Septic Tank Construction
James DeMilt at Glenn Rd
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 reviexved the application and location map of the project cited above and make the following
recommendations:
APPROVE ~
DISAPPROVE
Conmlents: ~
ELIZABETH A. NEVILLE "
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAOE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
· ,T°wn Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
sour holdtown.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 __
Application No. '~ q(~ 7
Permit No.
Applicant Name ~ ~,~
Applicant M~ng Address ~
Tr
Septic T~ ~or Cesspool
Brief Description of Propos~ Cons~cfion or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: "~ v9 r~_'3
Owner Mailing Address:
Owner Property Addres~s:y~J-
Name and phone number of contact person
Tax Map No: ['~O~ Section
Cross Street ..~c_~
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
S~e ~Applicant Date
Received l~y:
Block Or/ Lot ~.~_.~
/
/
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