HomeMy WebLinkAboutMoglia, John (2) . ELIZABETH A. NEVILLE
TOWN CLERK
HEGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southotdtown.north fork.net
OFFICE OF THE TOWN CLERK
TOWN OF $OUTHOLD
SOUTHOLD WASTEgVATER DISTRICT
APPLICATION
C?NSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
/
Residential ~ $10 V/ or Non-Residential ~ $25 Application No.~(4 .~' [
Applicant Name -.~
Applicani Mailing Address
Septic Tank///or Cesspool
Permit No.
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property:
O~vner Mailing Address:
Owner .,Property Address:
· Name and phone number of contact person
Tax Map No://dU~ Section?~i~
'77 Block
Cross Street ~. lr_.aLhf l o. '~.
Lot ~'
NOTE: LOCATION MAP MUST BI. SUBMITTED WITH APPLICATION. NEW
Signffture of Applicat/t '~" Date
Received by: .~.' C~
.J
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT O~.F.~. ]~
FREEDOM OF I~l · R
1 ~,~{r .. ~ i~ ~ "~J~rrICE or TIlE TOWN CLERK
' 0~- - - ' ~ TOWN OF SOUTHOLD
~0~ ,o . .
TO ~Town Building DepartmeRt
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: July 15, 2005
Transmitted herewith is a copy' of application No. 3491 for a Cesspool;Septic Tank Construction
Pemfit submitted by:
John Moglia
Please review the application and location map and advise if the project has received Suffolk Count3,'
Health Departlnent approval and if this office may issue the pemfit.
Please complete the foml 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
recomnlendations: ~
APPROVE
DISAPPROVE
Comments:
Signature
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