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Home My WebLink AboutBarrows, Mary & Don . ELIZABETH A. NEVILLE TOWN CLERK Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765.6145 Telephone (631) 765.1800 southoldtown.northfork.net REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER _.._' ,c, I 1'. >c., , \ I ~' i [~__ I , \ij\ MAR - 6 L"~S OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD \.-' ' I i . ,. 'Se.~ Building Department , \. j I ' l TO:lY'" FROM: Michelle 1. Martocchia, Southold Town Clerk's Office DATED: March 6, 2006 RE: Cesspool Constmctionl Alteration Application Transmitted herewith is a copy of application No. 3571 ConstmctionlAlteration Permit submitted by: for a Cesspool/Septic Tank Stacey Bishop- Future Surrouudiul!s Modular Homes. Please review the application and location map and advise ifthis 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 ofthe project cited above and make the following recommendations: APPROVE ~ DISAPPROVE C,mm"," ~~Zt:f?~:;~~*'-~ ~~ Signature ~~ ..-L Dated 7 ,:Lt1" ~ , . ELIZABETH A, NEVILLE TOWN CLERK REGISTRAR 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 sou thold town.northfork.net ( OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $lO..L.. or Non-Residential @ $25_ Application No.35 ')) Permit No. Applicant Name " J i)-Vo-Lel t_;/.S "iG- -::ft.<I"' ~'- ....:,.L.,'-,(t. '-'.JI'vt \ ,vl.--..~~L~ ~...:. 1--1." (,~J Applicant Mailing Address If 9' .' /' [ I" o 0 ("I"',-u...:_V'/(.':"'J .j<.' S'l;_..,-nt:.u, () /lc;,7( Septic Tank_or Cesspool~ Brief Description of Proposed Constmction or Alteration NeW /I/(,,J, e /J~ I.j,',-~,-: - -..i 1/\.)(;(.( ,'yj,-c.)/':'c/ .'\/u ( ,l_"~CV Location of Proposed Constmctionl Alteration: Owner of Property: Ii.(Hi-',' J ')c,.J ,7;,-0_,,-,,"''s Owner Mailing Address: / 0 7/? J "j /l~h, -; t. ,( /, r:H rb":'7' ..s.f Ll.~(((-- r/ " 1 '-I 9S- 7 Owner Property Address: ~ d. 'I L' /(:''-'-...J' I'-I(,.{ (, c, t'- .0 SC-IT-I-l.(X Y.) A '/ /1/7/ Name and phone number of contact person ':,.':H"'I ";/.Jd~ 7,.J C. )/7 Tax Map No: ILYc' Section ('I Block C--, Lot vlC, Cross Street ////.)1 ^) ,[ 0 NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL , Signature, of Applicant - ~ /' '- / { /oc . Date Received by: . ~ ~ ~ ~i ~ = fa :. 0>- 2 !!SiA .. ...... ...J~ 1 "'lil . E~~o~~~~~ ii~ ~li Ill.. 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