HomeMy WebLinkAboutGusmar Realty Corp ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MAHRIAGE OFFICER
RECOHDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 755-6145
Telephone (631) 765-1800
southoldtown.nor thfork.net
TO:
FROM:
DATED:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Toxvn Building Department
Linda J. Cooper, Southold Town Clerk's Office
September 22, 2005
2 2 200
Transmitted herewith is a copy of application No.
Permit submitted by:
3514 for a Cesspool/Septic Tank Construction
Gusmar Realty Corp. (Lot #2~)'--
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 fom~ below and return it to me.
Linda J. Cooper
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE J
DISAPPROVE
Comments:
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REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
.~Town Hail, §3095 Main Road
P.O. Box 1179
Sour. hold, New York 11971
F~x (631) 765-6145
Telephone (681) 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 or Non-Residential ~ $25 __
Applicant Name
Applicant Mailing Address
Application No.
Permit No.
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Name and phone number of contact person
Tax Map No: Section ~
Cross Street
Block ~)'~ Lot lO 1'7
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUII1ES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Received
Signatu/p of Atlplicant Date