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HomeMy WebLinkAboutWellmod Homes Corp 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 TO: FROM: DATED: Transmitted herewith is a copy of application No. ~ Permit submitted by: Welimod Homes Corp. Southold Town Building Department Linda J. Cooper, Southold Town Clerk's Office 3519 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 coniplete 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: b~ APPROVE DISAPPROVE Comments: Signature Dated ELIZABETH A. NEVH,I,~ .... TOWN CLERK REG-ISTILa. R 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 __ Applicant Name D,~\~ ~*~.~ Applicant Mailing Address ~_~ ~', Application No.~ Iq Permit No. Septic Tank ~/ or Cesspool Brief Description of. Proposed Construction or Alteration Location of Proposed Construction/Alteration: Owner of Property: ~qco~o~ Qma4x~'~0,. Owner Mailing Address: Own~ Prope~y Address: Name and phone ntunber of contact person Tax Map No: Section Cross Street ~"~' Block 5300 Lot dll.oaO NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL Si~Appl~_~ Received I~T. ~ Date