HomeMy WebLinkAboutBarbara, Maureen & Stephen ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FI{EEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
sour holdtown.northfork.net
TO:
FROM:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
"~"5 .: c, spf-'-''-I
TOW",! 2F S0'27' '-~ O.,._~
DATED: August 18, 2005
Cesspool Construction Application
Transmitted herewith is a copy of application No. 3501 for a Cesspool/Septic Tank Construction
Permit submitted by:
Maureen & Stephen Barbara
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me. Thank you.
I have reviewed the application and location map of the project cited above and make the folloxving
recommendations: ~
APPROVE
DISAPPROVE
Comments:
ELIZABETH A.
TOWN CLERK
REGISTRAt~ OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF IlffFORMATION 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 v// or Non-Residential ~ $25 __
Appli cant Name/44/)~e~-r~ ~v~o/4F_~m~ ~q/~t~ ~
Applicant Mailing Address ,~':~ t5).4/c ~--
Application No. 3-~%'~0 /
Permit No.
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: ,_~-t~JC~x~ ~ ,/}4A-o~J
O'~mer Mailing Address: ,~ ~ ~,4A~ ~'r-
Owner Prop erty Address:
Name trod phone number of contact person
Tax Map No: Section ~--~ Block .G Lot /~- c/
Cross Street /~1 CI~O.~ '1~ ~D
NOTE: LOCATION ~ MUST BE S~MITTED WITH ~PLICATION. ~W
S~Y, ~TH HE~TH D~T~NT APPROV~
CONSTRUCTION~Q~S ///~/ ~ ~O~
Si~amre of Applic~t Date
Received by: ~