HomeMy WebLinkAboutAngelson, Marilyn ELIZABETH A. NEVH,I.R
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT ~R
TO: ~,o~ohthold Town Building Department
FROM: Linda J. Cooper. Southold Town 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.north£ork.net
DATED:
Transmitted herewith is a cop3, of application No. 3496
Permit submitted by:
for a Cesspool/Septic Tailk Construction
Thomas C. Samuels
Please review the application and location map and advise if the project has received Suffolk Count.,,'
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to hie.
Linda J. Cooper
I have reviewed the application and location map of the project cited above and make the following
reconunendations: ~
APPROV£
Comments:
DISAPPROVE
Sigmature
Dated
ol~ic~ oF T~ ~OWN (~EK
TOWN O!~ ~OD'T~OLD
~ Y74BNT~ A. NEVll ] JR TOWN ~H~I~K
RO. BOX 1179
SOUTI~OLD. NEW YORK ! 19~l
Telephone
(63~) 765-1800
TOWN OF SOUTHOLD
· Application No.
Construction
Alteration
$10.00 - Residential
$25.00 - Non-Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION ·
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit NO. ~;)4C1{~)
Fee'S [0-~ ~)
DATE /~r_?; jOO~--
APPLICANT NAME: "~/~,~.~ ~t. ~~
APPLICANT ADDRESS: ~'~ ~,~ [~ ~..~ ~f~O~
SEPTIC V/ CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
,/V~F~,I ~,4m T,,~£ ~ ~' y,~TI~'7t~ fO/e,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ,ALTERATION:'
OWNER OF PROPERTY: ~A~'IL~.'/V
OWNER MAILING ADDRESS: 77(~
OWNER PROPERTY ADDRESS: 950
T,X ~,P ~o.: S~,on ]23 B,ock 7 ~o~
/
BUILDING PERMIT NUMBER GROSS REFERENCE:
'~Rcj'n~ture of Applicant
RECEIVED BY:
DATE:
Town Clerk's Office
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