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Home My WebLink AboutCalabrese, John & Joanne ELIZABETH A. NEVILLe, ' ~ TOWN CLERK REGISTRAR OF VITAL STATISTICS MARI~AGE OFFICER RECORDS MAIqAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER oFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD 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.ne~ Residential ~ $10 ~ or Non-Residential ~ $25 __ Application No.,'~K>%~ Permit No. ApplieantName ~,7~At~ vO-~,~ Applicant Mailing Address f.O. ~ -7oa Y' Septic Tank or Cesspool Brie£Description of Proposed Construction or Alteration Location of Proposed Construction/Alteration: OwaerofProperty'. -7'og~ +-3'-t~qt4~ Owner Msiling Address: ~a, 0. ~:q>~ 7 ~ 7 Owner Properly Address: I~ ~oU/~ Name and phone number of contact person ~J - "] ?'Pi- '-]hvJ( ) Tax Map No: {c~o Section ~ Block 0~ Lot Cross Street I ~/t.~T /~ef~ RoW NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL ~fure of App~cant Date ET,T~BETH A. N~VTT~T.~ TOWN CIA~EK 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: Southold Town Building Department Linda J. Cooper, Southold Town Clerk's Office 3575 for a Cesspool/Septic Tank Construction John & Joanne Calabrese 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: Signature Dated 0 / / S 50'56'10" W 113.24' 3SnOH~o NOII¥OOq 03SO~:)~d b