HomeMy WebLinkAboutEdson, Lisa ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
, ~U % ,..~ TO~ OF SOUTHOLD
TO: Southold To~ Building Dep~ment
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED: June 24, 2005
Transmitted herewith is a copy of application No.
Permit submitted by:
3483 for a Cesspool/Septic Tank Construction
Lisa Edson
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 return it to me.
Linda J. Cooper
I have reviewed the apphcat~on and location map of the project cited above and make the following
recommendations:
APPROVE J
DISAPPROVE
Comments: ~
Signature
ELIZABETH A, NEVILLE : ~ TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM~.zOF I~ORMATION OFFICER
~ ..~ ff oFFICE OF THE TOWN CLERK
x~/)~j , APPLicATioN
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.novthfork.net
Residential ~ $10/~ or Non-Residential ~ $25
Application No. ~°X4 %3
Permit No.
Applicant Name
Applicant Mailing Address
Septic Tank g or Cesspool
Brief Description of ~Propo?d Cons~tjuction~or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: ~. i~t ~/~Dr~
Owner Mailing Address: f~,~ ~'t~' ~FJ.~ ~
Owner Property Address:
Name and phone number of contact person
Tax Map No: /0t~O Section ~
Cross Street
Block
tnt ~,~'
NOTE: LOCATION MAP MUST BE SUBMITTED Vv'ITH APPLICATION. NEW
CONSTRUCTION REQUIRES SLIRVEy~~T~H DEPARTMENT APPROVAL
~ii~e of Applicant Date
Received l~y: ~
c~