HomeMy WebLinkAboutAkselrod, Evan ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
I~IARRIAGE OFFICER
RECORDS MLkNAGEMENT OFFICER
FREEDOI~! OF INFORMATION OFFICER
TO: ~S6uth~,~m~ilding Depaament
FR~ ~ kinda J. Cooper, Southold Iown Clerk's Office
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
DATED: July 13, 2005
Transmitted herewith is a cop)' of application No. 3489
Pemlit sabmitted by:
for a Cesspool/Septic Tank Construction
Evan Akselrod
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 pemfit.
Please complete the fom~ 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 ~
DISAPPROVE
OFFICE OF THE TOWN CI
TOWN OF SOUTHOLD
ELIZABETH A. N~VILLE, TOWN CLERK
P.O. BOX 1179
SOUTHOLD, NEW YORK 11971
Telephone
Application
Construction
Alteration
$10.00 - Residential
(516) 765-1801 $25.00-Non-Residential
d~~ll~ TOWN OF: SOUTNOLD
OLD WASTEWATER DISPOSAL DISTRICT
~ ~ APPLICATIO~N
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME:
APPLICANT AD DRESS:~/O
~. ~o~,c~
SEPT lC ~ESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION_~i_~__
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ~'~/~q~ ~1~&~-6.£~tl) -
OWNER MAILING ADDRESS: / q ~U~ 5r
~Y ~Y IOO07-
OWNER PROPERTY ADDRE55: ~ ~D~
TELEPHONE NUMBER OF CONTACT PERSON: .
TAX MAP NO.: Section ~ ~ Block ~ Lot
BUILDING PERMIT NUMBER CROSS REFERENCE:
Town Clerk's Office CATHEI{INE MESIANO, IN(:.
DATE: , -'~ I ~?_ Ic)~12 MILL POND LANE
E. MORICHES, NY 11940-1222
o 0
~ ~ ~<
/4.0E.6 L.90S
\
\
\
\
Y
\
\
l~:lns