HomeMy WebLinkAboutMarco, Phil (2) ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE O F~FJ. ~R~
RECORDS MANAgEMeNTiO?,FICER
FREEDOM~.O~FJ~NI~?It~IA~ION[?FFICER~ ~. . .
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building Department
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: Michelle L. Martocchia, Southold Town Clerk's Office
DATED: November 30, 2005
Cesspool Construction Application
Transmitted herewith is a copy of application No. 3545
Construction Permit submitted by:
for a Cesspool/Septic Tank
Carl Ar~ila
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me. Thank you.
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE ~
DISAPPROVE
Si~ature
Dated
ELIZABETH A. NEVH,I,~,
TOWN CLERK
EEGISTHAR 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 (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 ~'/oor Non-Residential ~ $25 __
Applicant Mailing Address oC~ y)/[ ~r_ {.tlr/?I$'l{
Septic Tank or Cesspool ~__.-~'
Brief Description of Proposed Construction or Alteration
Application No.~g 5/)
Permit No.
Location of Proposed Constmction/Altgrgtign~
Owner of Property:
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person
Tax Map No:/tO'~'O Section ¢'~"~ Block
Cross Street
g71 Lot ~2'3
NOTE: LOCATION MAP MUST 1~ SU.~BI~ITTED~ WIT[~ APPLICATION. NEW
CONSTRUCTION REQUIRES SURVE1 ~qITH }nEAL~XI4 D ]~ kRTMENT APPRQVAL
signa ~f~pFl~c%~ \1\I Da¢ '{ -
Received by: C)'7
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