HomeMy WebLinkAboutShoreline Development ELIZABETH A. NEV]I.r.~
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FRE~ INk'X)i~ATION OFFICER
i tt !! n~.V o ~ onn~ ~ i i OFFICE OF TOWN CLERK
LILI, u~,~ L u cuuo i'.~'i TOWN THE
'~ L ............. ! J OF SOUTHOLD
I TO~'. g$iithdld~l.;~______~uilding Department
TO:
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED: October 26, 2005
Transmitted herewith is a copy of application No. 3535
Permit submitted by:
for a Cesspool/Septic Tank Construction
Shoreline Develooment Coro.
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
Signature
Dated
EIJ~.~BETH A. N'~VI~J.E
TOWN CLEI~K
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MA_~AGEM~NT 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
Permit No.
Septic Tank or Cesspool [./'-
Brief Description of Proposed Construction or Alteration
Location of Proposed Constr~u~cfion/Al[eration:,.. 1 ,
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact perso?
Tax Map No: Section
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION m QUnU s st w¥ WlT It nI T!t DEPArTMeNT,APPROVAl
,/~2/" ) Silage of Applic~t
Received by[_~ ..........
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