HomeMy WebLinkAboutVerity, Michael ELIZABETH A. NEVILLE
TOV~N CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGE M EI~OI~R
, ~,, ~ ~ · ~)FFICE OF THE TOWN CLERK
~ ~ °~- _~._~ ' \ TOWN OF SOUTHOLD
TO: L..~-.'"'~Southold Town Building Department
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED: July 11, 2005
Transmitted herewith is a copy of application No.
Permit submitted by:
Michael Verity
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax ~631) 765-6145
Telephone (631) 765-1800
southoldtown.nort h fork.net
3487 for a Cesspool/Septic Tank Construction
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:
APPROVE
DISAPPROVE
Comments:
~ignature
ELIZABETH A. NEVILLE "
TOWN CLERK
REGISTHAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFO1LMATION OFFICER
· ~Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New Yerk [1971
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 ~ $I0 o~r Non-Residential ~ $25 __ Application No~ ~/7
Permit No.
Applicant Name~ ~~
~,//a/ling Address ~.~, ~
Brief Desc, ription of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner Mailing Address~
Owner ., · _
Property Address:
Name and phone number of contact person
Tax Map No: _ Section 3~"-- ~ -Block._~_____ Lot
NOTE: LOCATION MAP MUST BE SUBMITrED WITR APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WlTlt I~EALTH DEPARTMENT APPROVAL
.
Received IJy:
0'~o~ ~?~W
\
\
\
\
\
\
\
\
0
o
:$3.LON
)t~Ok ~3N 40 kN¥cll~O9 3~NY~$NI
3'IJ.U. ONV"~
3J.I~3A 'P '13VHOII~I
L6g-~o0~ :ON 80r
~o0: 'i,t 'AON :3J. VO
gO0~ '§L
VIVO 3~OH IS3J.