HomeMy WebLinkAboutCacioppo, Paul ELIZABETH A. NEVILLE
TOWN CLERK
REGISTtL~kR OF VITAL STATISTICS
IVL~,RRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
~E oOM~?.~ mr~=oL&q FFICE ~
~} ~m 0 ~ ~ TO~OFSOUTHOLD
~n Building Depa~ment
Town Hail, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.north fork.net
FROM:
Linda J. Cooper, Southold Toxvn Clerk's Office
DATED: June 1, 2005
Transmitted herewith is a copy of application No. 3473 for a Cesspool/Septic Tank Construction
Permit submitted by:
Boulevard Planning East
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 below and retum 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 Y
DISAPPROVE
Comments:
Signature
D
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hail, 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 ~ $10 ~ or Non-Residential ~ $25 __
Application No. 3q'~ '~
Permit No.
Applicant Name ~
Applicant Mailing Address 3~F~g.~'' /J/J~t~ ~/~
Septic Tank ~ or Cesspool .~
Brief Description of Proposed Construction or Alteration~~x~~t
Location of Proposed Construction/Alteration:
!
Owner of Property:
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person
TaxMap No: IOoO Section
Cross Street ~t~t~t ~
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APP~.~CATION. NEW
~e~pl~ Date
Received by:
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