HomeMy WebLinkAboutManley, Robert ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INF~I~a~J~ OFFICER
~Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
DATED: November 15, 2005
Transmitted herewith is a copy of application No. 3541
Permit submitted by:
for a Cesspool/Septic Tank Construction
Robert & Donna Manlev
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 retum 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
DISAPPROVE
Comments:
Signature
ELIZABETH A. NEV~J,F, '"
TOWN CLERK
RI~GISTRAR 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 (831) 765-8145
Telephone (631) 765-1800
southoldiown.northfork.ne~
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 __
Application No.
Permit No.
Location of Proposed Construct/on/Alteration:
OwnerofProperty: 2o/~r*e -/ ~ -~.~
Owner Mailing Address:
Owner Property Address:
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signature of Applicant
Date
Name and phone number of contact person
Tax Map No: / ~ Section 5
Cross Street ~.o du ~ ~ C~'.
Block 5 Lot 0¢