HomeMy WebLinkAboutAnderson, John EI,I~,BETH A. NEVII,I,F,
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGFaMIg~OFFICER
FI EEDOM OFFICER
, '(' \/ ~! ~-
~~ Sou~old Town B~ld~ Depment
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.nor th fork.net
FROM:
Michelle L. Martocchia, Southold Town Clerk's Office
DATED: November 21, 2005
REi
Cesspool Construction Application
Transmitted herewith is a copy of application No. 3542
Construction Permit submitted by:
for a Cesspool/Septic Tank
John Anderson c/o Suffolk Environ. Consultinu
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and retum it to me. Thank you.
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE J
DISAPPROVE
Dated
REGISTBAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFOILMATION 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 er ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 X or Non-Residential ~ $25 __ Application
Pcrmit No. ~
Applicant Name John Anderson(c/o Suffolk Environ. Consulting, Inc. )
P.O. Box 1329; Southold, NY 11977
Applicant Mailing Address
Septic Tank x or Cesspool
Brief Description of Proposed Construction or Alteration Applicant proposes to
construct a single family dwelling and appurtenanQes
Location of Proposed Construction/Alteration:
Owner of Property: John Anderson
Owner Mailing Address: P.O. Box 1329;
Southold, NY 11977
Owner Property Address:
s/s Parish Drive North. Bayview.
Name and phone number of contact person Matt Ivans: 631 -537-5160
Tax Map No: Section 071 Block 01 Lot 033
Cross Street 280' west of Dayton Road
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
SFgffature of Applicant Date