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Home My WebLink AboutSalous, T 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: September 28, 2005 Transmitted herewith is a copy of application No. Permit submitted by: Chris Rivera for T. Salous Southold Town Building DepaVxnent Linda J. Cooper, Southold Town Clerk's Office 3520 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 Comments: Dated ]~1 J~.&BETH A. NEV~.LF. TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MA/~AGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main 1%ad 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 ~'/°r Non-Residential ~ $25 __ Application No. b~ Permit No. ~ . Applicant Name ~'~/.s- ~ e~'~ Applicant Mailing Address ~.~,a .~,~, 2 ~ ~. Septic Tank -~'~or Cesspool / Brief Description of Proposed Construction or Alteration Location of Proposed Construction/Alteration: Owner of Property: Owner Mailing Address: Owner Property Address: Tax Map No:/~'~. Section/~ ~> Block__Lot Cross Stxeet /~~a~ NOTE: LOCATION ~ M~ST BE S~M~ED ~T~ ~PLICATION. NEW CONSTRUCTION ~Q~S S~Y ~T~E~ DEP~T~ ~ROV~ Si~amre~pplic~t / / / Date R~eiv~ b~/ ~-lO::t::tf~ :dO A J-NflO~9 CIqOH_LflOG -lO NIMO£ 4gO_~O-SyOl-O001 ~ '14'J.'~)'~ AN '~l~)fl-LIJ-j-Vk4 Nl~qd I / / / q,o oS-- I ,00'0;~!