HomeMy WebLinkAboutBravo Contracting ELIZABETH A. NEV~,LF.
TOWN 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.northf0rk.net
TO:
FROM:
DATED:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
September 22, 2005
Transmitted herewith is a copy of application No. 3516 for a Cesspool/Septic Tank Construction
Permit submitted by:
Bravo Contracting (Lot #12)
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form beloxv and return it to me.
Linda J. Cooper
I have reviewed the application and location map of the project cited above and make the folloxving
recommendations:
.~PPROVE ~
DISAPPROVE
Comments:
Dated
ELIZABETH A. NEVH,LE ':--
TOWN CLERK
REGISTRAR OF VITAL STATISTIC~ ·
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
..Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
Residential ~ S10g,/ or Non-Residential ~ $25 __
Application No. ~qt~
Permit No.
Location of Proposed Construction/Alteration:
Owner of Property: '~ g~
Owner Mailing Address: ~ ~ ~
'Lt-
OwnerPropertyAddress: ~.~- _~_~. I~L ~U~-&t-~T
Name and phone number of contact person ~}J~J~
Tax Map No: Section ~ ~ Block
Cross Streot LIA? I t3 A
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION, NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signature of Applicant Date
Received IJy:. ~
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