HomeMy WebLinkAboutSolomon, Ed El,IX&BETH A. NEVH,I,E
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
_ T~owH Hall, 53095 Main Road
· 2 '/2005 q-P.O. Sox
.... .jSou~hold, New York 11971
5' r.~ , . T. l~ax (631) 765-6145
.'~hone (631) 765-1800
southoldtown.northfork, net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO:
FROM:
DATED: September 23, 2005
Transmitted herewith is a copy of application No.
Permit submitted by:
Samuels & Steelman (owner Ed Solomon)
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
3517 for a Cesspool/Septic Tank Construction
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 /
DISAPPROVE
OFi~/~ OF ~ TOWN CI,E~/
TO~/~ OF ~O~THOLD
~h'TH A. NBVILL~, TOWN CL//RK
P.O. BOX 1179
SOUTHOLD, N~W YORK ! 1971
Telephone
($3~) 765-1800
Application No.~
Construction
Alteration
$10.00 ~ Residential I~/
$25,00 - Non-Residential~
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit NO.
APPLICANT ADDRESS: o~3~'/~//~
SEPTIC ~CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be Issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: ,~'~)
OWNER MAILING ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO.: Section ]/L~ , .Block
CROSS STREET: ~'-/"'~//7//~[/~ ~/~"
BUILDING PERMIT NUMBER CROSS REFERENCE:
RECEIVED BY:
DATE:
~rk' s
ature of Applicant
Office
/ /
/ /
/ /
/ /
/
/ / /
/ / /
I/
/ /
x/ / .
:/
/
/
/
/
/
/
/
/
/