HomeMy WebLinkAboutEsteves, Manuel ET,TZ&BETH A. hrgyTT,T,~,,
TOWN CT,~RK
REGIST~ OF ~T~ STATISTICS
~GE OFFICE~
RECORDS ~AGEMENT OFFICER
F~EDOM OF ~FO~TION OFnCER
I 6 2005
',' .... _~
TO:
OFFICE OF THE TOWN CLEHK
TOWN OF SOUTHOLD
Southold Tox~q~ Building Department
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 copy of application No. 3508
Permit submitted by:
['or a Cesspool/Septic Tank Construction
Roberts Custom Homes
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
I~LTZABETH A. NEV~'~LE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRL~GE OFFICER
RECORDS M~IAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF $OUTHOLD
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 ~ $10 ~
Applicant Mailing Ad.dress ~
Septic Tank__~_r~r Cesspool
__ or Non-Residential ~ $25 __
Brief Descrip6,on of Proposed Constmctio,n or Alteration
Location of Proposed Construction/Alteration:
OwnerofProperty: ~ tsJa_~...~ ~'~4'~I/[~--~
Owner Mailing Address:
Owner Property Address:
~e ~d p~one.,~ber off.tm perso. ~[C.~
Ta~pNo: S~tio. ,z-/5- ~loo~
Application No. 73._~ C)<:~
Permit No.
Lot
Cross Street
NOTE: LOCATION MAP MIIST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
'<-rd .
Signature of Applicant Date
Receivedl~y: ~- ~