HomeMy WebLinkAboutHeffernan, Dennis & Suzanne./
EIJZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF V~TAL STATISTICS
MARRIAGE OFFICER
REC(
FREEr
TO:
~EI~T. XlF~?iC E R
j~j AUS 2 5 200~ ,' FFICE OF
THE TOWN CLERK
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/
Southold Town Building Department
FROM:
Linda J. Cogper. Southold Town Clerk's Office
DATED: August 24, 2005
Cesspool Construction Application
Transmitted herewith is a copy of application No. 3502
Construction Permit submitted by:
for a Cesspool/Septic Tank
Dennis & Suzanne Heffernan
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
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.
1 have reviewed the application and location map of the project cited above and make the folloxving
recommendations: ~
APPROVE
Cornments:
DISAPPROVE
ELIZABETH A, NEVILLE '~
TOWN CLERK
REGISTRAR OF VITAL STATISTICS ' '~''
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFOiL~IATION OFFICER
..Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Te]ophone (631 ) 765-1800
southoldtown.northfork.ne/
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
,Residential @ $10 /or Non-Residential ~ $25 __
Applicant Mailing Address
Septic T~ or C~ool
Brief Description of propos~ Co~mcfion or ~te~fion
Application No. __
Permit No.
Location of Proposed Construction/Alteration:
Owner of Property.' 1~00 3L/(~ L
Owner Mailing Address:
Owner Property Address:
)
Name and phone number of con~o~ ~'[]~/}~.~ ~4~~
TaxMapNo: S~tion ~]OC__) Block (~r~ Lot
Cross S reet D
NOTE: LOCATION MAP MUST BE SUBMrrTED WITH APPLICATION.
NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Received I{y:
~ rY f:UFFOLX
., SKUNK LANE (OR BAY AVENUE)
1 k, XX 4 90.00
HO~sE CO,R4t