HomeMy WebLinkAboutMartin, James & Denise
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ELIZABETH A, NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOMO~ I~FO~1f:\.!I()N OFF~ER
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\' ~ I " ----: ii' I OFFICE OF THE TOWN CLERK
I APR - 1 I '1 TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P,O, Box 1179
Southold, New York 11971
Fax (631) 765-61415
Telephone (631) 765-1800
southoldtown .northfork.net
TO:
, ,
'South~(d Towrr~uilding Department
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 3585 for a Cesspool/Septic Tank Constmction or
Alteration Permit submitted by:
James & Denise Martin
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
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I have reviewed the application and location map of the project cited above and make the following
recommendations:
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APPROVE
DISAPPROVE
Comments:
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ru.~tY/Lp
Signature
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Dated
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,
Telephone
(631) 765-1800
Application No. ~
construction~
Alteration
$10.00 - Residential
$25.00 - Non-Residential
omCl OFTBB TOWN CLJIlK
TOWN or SOtTl'BOLD
EUZABETIl A. NEVII.LE, TOWN CLERK
P,O, BOX 1179
SOU11l0ID,NEWYORK 11971
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$
DATE ~~/()lp
APPLICANT NAME: -=rt1~ eD1Nl1J~~ rVi.drb'^-
APPLICANT ADDRESS:---Jj Ua;t- (pr S~, 4pA -it gf3
..J NY ! ~lOU~\ ..
SEPTIC~CESSPOOL
DESCRIPTION OF PROPOSED C NSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
,OWNER OF PROPERTY: ::J&,M.p/\ +- ~'.DL ~I.A.....
OWNER MAILING ADDRESS: JJ ~ l;i0"^-SJ-.~.Jtff3
Nvt tvvt I~I
OWNER PROPERTY ADD~k~~r ~ Wct'-t
TELEPHONI; NUMBER OF CONTACT PERSON: ,3Y-(oVO-S-
TAX MAP NO.: Section-J J to Block ~ Lot 3/
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE: . {}.,P#- 3o{oo ~ z....
Ignature of Applicant
RECEIVED BY: ~~.
, Town' C erk's Office
DATE: 1f/7/a;:J
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