HomeMy WebLinkAboutGusmar Realty corp (2) ELIZABETH A. NEVILLE
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.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD i
TO:
FROM:
DATED:
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
September 22, 2005
2 2
Transmitted herewith is a copy of application No, 3513
Permit submitted by:
for a Cesspool/Septic Tank Construction
Gusmar Realty Corp. (Lot #28)
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 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: ~
Signature
Dated
ELITABETH A. NEVILLE '
TOWN CLERK
REOISTBAR OF VITAL STATISTICS
MARRIAGE 0FF/CER
RECORDS MANA(IEMENT OFFICER
FREEDOM OF INFORMATION' OFFICEB
.,Town Hall, 53095 Main Roa
P.O. Box 1179
Southolc~, New York 11971
Fax (831) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PEI~fflT
CESSPOOL or SEPTIC TANK
Residential ~ $10 or
Applicant Name ff,~ ~ ~M
Applicant Mailing Address
Non-Residential ~ $25 __
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Application No.
Permit No.
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: (~qt$ t.~ ~12. ~-lDq CTq
Owner Mailing Address: l..~-- I-~
Owner Propen~yAddress: ~,o/~
Name and phone number of contact person
Tax Map No: Section
Cross Street ' f'4 k a3
Lot
NOTE: LOCATION MAP MUST BE SUBMITTED ~rlTH APPLICATION, NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
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