HomeMy WebLinkAboutJLH Associates ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INF~ORM.&~tO~FFICER
d,, _ _ ~ .~- ~ O~FICE OF THE TO~ CLERK
~ ~uthold Tm~n~ Budding DepmXmeot
Town Hall, 53095 Main Road
P.O. Box I179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southo]dtown:nor t h fork.net
FROM:
Linda J. Cooper. Southold Town Clerk's Office
DATED: June 6, 2005
Transmitted herewith is a copy of application No. 3474
Permit submitted by:
for a Cesspool/Septic Tank Construction
JLH Assoc. iates~ LLC
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 l'orm 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
Comments:
DISAPPROVE
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECOHDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
~ 'd SOUTHOLD WASTEWATER DISTRICT
~ ~7, APPLICATION
Z CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
Residential ~ $10 j or Non-Residential ~ $25 __
Application No. ~O~q t~
Permit No.
Applicant Name ~'Llff ~,550C IA?e5 L/_ C
/
Applicant Mailing Address
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: ~ t_ b~ i~S Soc
Owner Mailing Address: f,C~.
Owner Property Addres~i~ ~ff
Name and phone number of contact person
Tax Map No: Section '~-~
Cross Street t~/A/~ /~b (lq ~.
Block 0 ~ Lot
_5-5-3 .-
l/
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WIT~ HEALTH DEPARTMENT APPROVAL
~---'"Sg~t~re o'fApplicant t/ / Date
Received by: