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HomeMy WebLinkAboutBrokaw, Bennett (,--' " Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.northfork.net ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD /:,"-. / ' . .-......:'- , TO: Southold Town Building Department FROM: Michelle L. Martocchia, Southold Town Clerk's Office DATED: May 17,2007 RE: Cesspool Construction/Alteration Application Transmitted herewith is a copy of application No. 3711 for a Cesspool/Septic Tank Construction/Alteration Permit submitted by: Bennett Brokaw 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 v-- DISAPPROVE Co=rn" -~'fj~'f~~~ Si~~ ~6~1 ~7 Dated f ' L' EUZABETH A. NEVILLE .. ~ , TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECQRDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER .:':.~ .. Town Hall, 58095 Main RollI -, P.O. Box 1179 . South,old, New York 11971 Fax (681) 766.6145 Telephone (681) 765-1800 8outholdtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $1 j' or Non-Residential @ $25 _ Application No.3JlJ. Permit No. Applicant Name Applicant Mailing Address -'tA..J ~ Septic Tank_or Cesspool Brief Description Of~OSed Constructiono.r Alteration hc-U/ /~/?m/ . . Location of Proposed co~~~t~tio~:. &44.e ;! Owner of Property: (:1 /? .;~ s Owner Mailing Address: .:/ dl2 -0ltl.e I/Jc .p . Owner Property Address: Name and phone number of contact person Tax Map No:/tiO~Section / /,3' Block ();/ Lot .z/ Cr~ss Street ~ ~A ~ll.e NOTE: LOCATION MAP MUST BE SUBMITTED WI'rH APPLICATION. NEW <WNSTRUCTION REQUIRES SURVEY WITH m ~~NT AP ~ ~~ ~057 Signature of Applicant te . ReceiVed~,~_C1. 5Jll/0f ...1..\ . ,Olo\Mllf.:J" WlfL'.. .~. c.f!Ir"~"'" " f)W'F:LUJ~ ~LL. ~ ctc.(p\J.I~ I S"t7 I Lo T l.. f)i/(rt. .'Ii't1' i I i , , I ! / I -~--- r .J I G,.1 ~,.;,' ~I.l"" /'I ' 2 (g.o r-J l1'" I '0. ~ ~ .~ --- l - rn . "\ 1\1 ) ) ! l !. - ~ \,/1 I ~ I ..., ') \) .J ~ ~ <( It 'U -~'" ~\I( .". ~\J.l \J '" ...) t -J"LI. ~~ ~ ..~ -, \ DfI., '. . .vE:. SUFFOLK COUNTY DEPARTMENT OF HEALiH '5EilV!C;::S PERMIT FOR ApPROVAL OF CONSTRUCTION FOR A SINGLE FAMILY RESIl)ENCE ONLY .-....~ I. c::. c:-, ,.. .-\. I .~~r€.N<'f- l .....r.i \ 1 " T ti"L~ .Lf.v fl. 0 \ .. \ \ j )1. fp.oJf ~ -WlL'" j \~ 1'12"", 2. rr( . IU" t)(\J~ "i! 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