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HomeMy WebLinkAboutGillooly, William L. ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARR La. GE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFQ _RN~.~T-L~OFFICER - !~"I OFFICE OF THE TOWN CLERK ~~T~,vn Bmld~ng Dep~ment Town Hall, 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 Town Clerk's Office DATED: June 20, 2005 Transmitted herewith is a copy of application No. 3480 for a Cesspool/Septic Tank Construction Permit submitted by: William L Gillooly 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 beloxv 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: j APPROVE DISAPPROVE Comments: ELIZABETH A. NEVILLE TOWN CLERK REGISTBAR OF VITAL STATISTICS MARRIAGE OFFICEH RECORDS MANAGEMENT OFFICER FREEDOM OF INFOILMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 $outhold, 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 __ Applicant Name /A~///- //T~4A L ~t {-~.OOq Applicant Mailing Address ~0}( ~'~ ~)~/~-- .ff~ Application No. ~ qg 0 Permit No. Septic Tank_)~_or Cesspool ~' Brief Description of Proposed Construction or Alteration Location of Proposed Construction/Alteration: Owner of Property: (~2 'a/4 ~, C~.t LL oo t~f Owner Mailing Address: ~Or ~ ~/~ Owner Property Address: t~.f~t~ ~/~7'- Name and phone number of contact person Tax Map No:/(.3~5 Section -~"7 Cross Street C>t2 V-r tq0,r/ Block ~/ Lot ~ NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION arQmm~s SUR~/~W~Tn.I~E~LTH DEPAaTMENT APPROVAL //?f~ /, ~/S{gtfiatur~/o f A~ic ant Date /'