HomeMy WebLinkAboutDey, Douglas ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STAT[ST[CS
MARRIAGE OFFICER
RECORDS MLANAGEMENT OFFIC~_,~.
FREEOOM OF INFOR~%T4ON ~FIL'~
'~,~1,t~,. ~'a'~, ~ ', ~ TOWN OF SOUTHOLD
TO: ~tn-~ ' Building' ' Department
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, Ne,v York 11971
Fax (631) 765-6145
Telephone (63D 765-1800
southoldtown.nor th fork.net
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED: May 19, 2005
Transmitted herewith is a copy of application No. 3469
Permit sublnitted by:
for a Cesspool/Septic Tank Construction
Samuels & Steelman (for Douglas Dey)
Please review the application and location map and advise if the project has received Suffolk Count3,
Health Department approval and if this office ma3,' issue the permit.
Please complete the form below 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
Signature
OFF/(~ OF 111~ TOWN CLEi~
TOWN OF ~Ob'T~OLD
ELIT-ABLrrH A. NEVILLe, TOWN CI2RK
P.O. BOX [ 1']9
$OUTHOLD. N~W YORK l 1971
Telephone
(631:) 755-1800
Construction
Alteration
$10.00 - Residential ~'
$25.00 - Non-Residential
TOWN OF SOUTHOLD
~ "
SOUTNOLD WASTEWATER DISPOSAL DISTRICT
A, PPLICATION .
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
APPLICANT ADDRESS: 2~z¢~/~ ~
SEPTIC ~ CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ,ALTERATION:'
OWNER OP PROPERTY: ~:~g~- b~--~/
OWNER MA,L,NG ADDRESS: CC;IS
OWNER PROPERTY ADDRESS: /~ ~/([,~/~ ~.
TELEPHONE NUMBER OF CONTACT PERSON:
RECEIVED BY.'~
)wn Clerk's Office
/~ignature of Applicant
LZ
SouND
I SHELTE+R ISLAND
$ 20'11'26' W ~ 175.56'
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