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Home My WebLink AboutKerbs, John ELIZABETH A. TO~ CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER TO: ..... ? ,. ¥So~th.ld To~u Building Department OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.northfork.net FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: Transmitted herewith is a cop3' of application No. 3504 for a Cesspool/Septic Tank Construction Permit submitted by: John&JanisKerbs 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 pemfit. 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 DISAPPROVE Comments: Signature Dated EIJZ&BETH A. NEV~,LE -- 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 SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential ~ $10 ',/ or Non-Residential ~ $25 __ ) Permit No. Septic Tank or Cesspool ,~ Brief Description of Proposed Construction or Alteration ~ ~.', ~ ~ LoeationofProposedCons~ruction/Alterat~n: ~,OJO~ ~t~to..~//k- OwnerofProperty: ,.3~Ot~_ ~ ._..)~o_t~,.A. ~ .:~ Owner Mailing Address: Owner Property Address: Application No.~ Name and phone number of contact person ,.~ I, ~,. Tax Map No: {ov~ Section ~'~ Block ~ Lot Cross Street ~p~_ ~ NOTE: LOCATION ~ MUST BE SUBMITTED WITfl A~PLICAT][ON. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTh[ DEPAtgTMENT d itl