HomeMy WebLinkAboutKozora, Judy ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INF~?X~aTIOI~ OFFICER
i[~I[ ,,n. 7 ~c~r illJ!l OFFICE OF THE TOWN CLERK
LJLJ I I~IUV ~ ~J , ~ I TOWN OF SOUTHOLD
TOVVNO~St}Ui, OL''h' J . .
TO: Southold Town Bmlding Department
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.nor thfork.net
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 4, 2005
Transmitted herewith is a copy of application No. 3540
Permit submitted by:
for a Cesspool/Septic Tank Construction
R & R Builders
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 J
Comments:
DISAPPROVE
Signature
Dated
ELIZABETH A. NEV]LT,~
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hsll, 53095 Main Read
P.O. Box 1179
Southold, New York 11971
F~x (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 ~--?/-'~(--- ~"~ t
Applicant Mailing Address "~0 ~0~.
Brief Description of Proposed Construction or Alteration
Application No. ~~-'1~0
Permit No.
Location of Proposed Construction/Alteration:
Owner of Property: ~
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person
TaxmapNo: [eo~ Section --]c~ Bloc!~ ~ Lot
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRVCT ON m otam s stmv ¥ WITI }IE, TH OEP aXTMI NT API'ROV
· Datt
~~ Signature o f Applicant
Received by:
/
JOkIN C. EI-ILBRS LAND SURVEYOR