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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