HomeMy WebLinkAboutTapp, Robert & Ellis, Nick
J
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANA<JEMEN'fOFFICER
FRf.EDtWOFiN~IfMATION O~FICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
Boutholdtown.northfork.net
\JIP>.~ 3 \ ? S .-.-, OFFICE OF THE TOWN CLERK
.- -,j TOWN OF SOUTHOLD
L't"~---~"-,-~_~J' :~~\\':)LO
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TO: Southold Town Building Department
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 3602 for a Cesspool/Septic Tank Construction or
Alteration Permit submitted by:
Tom Samuels
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:
APPROVE
/
DISAPPROVE
C"mmoo," _~~~~~~~
,
~~~
Signat; t.~ ~ t;;
, ,
Dated
.
oma OFTBE TOWN CLERK
TOWN or SOVl'llOLl>
~ EUZABETII A. NEVIILE, TOWN CLERK
P.O, BOX 1179
SOUlllOlD. NEW YORK 11971
Appll"'Uon NO'~
Construction
Telephone
(631) 765-1fjJJO~ '
C fl.d'):tP~ TOWN OF SOUTHO~D
D ~ . rf~ SOUTHOLO WASTEWATER DISPOSAL DISTRICT
Alteration
$10.00 -Residential
$25.00 - Non-Residential
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$
DATE
. APPLICANT NAME: W41 Mm()li&S'
APPLICANT ADDRESS: b?S236 iW4/JJ /CJ).
CAtrcHo~. #1' '
SEPTIC (" CESSPOOL .
DESCRlmoN OF PROPOSED CONSTRUCTION OR ALTERATION M+vA:?A!..ttillT
Df F;1'IST/A;6 04AJ/7If1<.'( r Loh6/I'C.{CTt"D1./ c{-' ;U~ SrSrc7t1
.5/JO/6b
.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: R..dlel?T 7/1-flP 'r A//CK GZUS
OWNER MAILING ADDRESS: fJo I5v'x: /064 C<<rC? HtJ 6U&-
I
OWNER PROPERTY ADDRESS: :(7...5 tuGS! .R../J.. CttTC ffoea;-
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO.: Section /10 Block EJ7
CROSS STREET: ~Ecp(jASII ;1ve7/j()&
BUILDING PERMIT NUMBER CROSS REFERENCE:
-;&t. LffD /
Lot II, I
.
. ~"'"anl
RECEIVED BY: 'f-v~ -, .
own Clerk's Office
DATE:5\~~CiD
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