HomeMy WebLinkAboutPrizeman, John ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
I:,,'A ~-~ OFFICE OF THE TOWN
CLERK
l__:_. _,
;- T 6'dt atd TOwn BuUding Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
Town Hall, 53095 Main Road
P.O. Box 1179
Southotd, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.nort h fork.net
DATED:
Transulitted herewith is a cop)' of application No. 3499
Pemfit submitted by:
for a Cesspool/Septic Tank Construction
John Prizeman
Please review the application and location map and advise il'the project has received Suffolk County
Health Department approval and if this office ma3' issue the permit.
Please complete the fom~ below and return it to me.
Linda J. Cooper
[ have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE /
DISAPPROVE
Colnnlents; ~
Dated
ELIZABETH A. NEVTT,T.~
TOW~ CLERK
REGISTRAR 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
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__
,/
Non-Residential ~ $25 __
Application No. ~ q q
Permit No.
Applicant Name TO ~{
Applicant Mailing Address
eptic Tank -for Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
OwnerofPropei~y: TO iai r,V 12/2.
Owner Mailing Address: ~2~[ c/ /~
Name =~ ~o~ ~o~o~ta~t V~o~ ~O~r~' ff~ 2~ Z/~ ~Z~ O ~ ~4
T~ Map No: Section/~ ~ ~lock ~ ~ -- ~ Z ~
Cross S~eet ~'~ e ~ ~ ~5 _~; C[~
NOTE: LOCATION ~ ~ST BE S~MITTED WITH ~PLICATION. NEW
~QU~S SUR Y ~It ~E~T~EP~T~T APPROV~
4~ Zoo ~
Si~re of Applic~t ~ ; Date
Received by:~~ ~
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