HomeMy WebLinkAboutHorton, Debra ELIZABETH A. NEVH
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) 765r1800
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:
Debra Horton
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
October 21, 2005
3530
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:
Signature
Dated
OFFICE OF 'r~lg TOWN CLERK
TOWN OF SOI%IItOLI)
~i,IZABETH A. NI~VlLI~ TOWN CI~P.K
P,O. BOX i1'/9
SOUT[fOLD, NEW YORK 11971
TelePhone
(63~) 765-1800
Application No.
Construction
Alteration j
$10.00 - Residential
$25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
LOCATION MAP: Must be attached hereto before permit may be issue~,
LOCAT,ON OF PROPOSED ~S~RUCT,O.~ OR ALTERAT,ON:'~e~
OWNER OF PROPERTY:
TAX MAP NO.: Section
BUILDING PERMIT NUMBER CROSS REFERENCE:
SignAture of Appllc~nt
RECEIVED BY://'~
Town Clerk's Office
DATE:
DE RoBE D, FEI)UN
i~ publb, State ol New Yor
No. 4994281
N
LOT NUMBERS REFER TO "MAP OF' VISTA BLUFF" FILED
tN THE SUFFOLK COUNTY CLERK'S OFFICE ON MARCH
15, 1968 AS FILE NO. 5060.
ELEVATIONS REFERENCED TO N.G.V.D.
FuR SANITARY SYSTEM I
~ !,~,EAL TH ~EP/~ RTMENT I
SUFFOLR COLI~TY DEPARTMENT 01: HEALTH SERVICES
,>~G~ F~ ..~ ~E~ ONLY
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SURVEY OF PROPERTY
A T CUTCHO~UE
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
1000-83-01-13
S~ALE.: I~-30'
JANUARY 13. 2004
Nov. 2~, 200~I frevl~ionr,)
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