HomeMy WebLinkAboutO'Brien
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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 STA'I'~STICS
MARRIAGE OF~~CER
RECORDSMANAGEMENT6F~CER
FREEDO.M;OFlf1.F\O....~TIbNO ICER
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TO: . Southold Town Building Department
~ OFFICE OF THE TOWN CLERK
/~. TOWN OF SOUTHOLD
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED:
September 28, 2007
Transmitted herewith is a copy of application No. 3746 for a Cesspool/Septic Tank Construction
Permit submitted by:
Garrett Stranl! for O'Brien
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 retum 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
Comments:
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Signature
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Dated / /
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
., Town Hall, 53095 Main Rc
'P.O. Box 1179
Southo1d, New York 1197
Fax (631) 766.614,5
Telephone (631) 765.1801
sou tholdtown. northfork. no
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $1 0 '! or Non.Res;dential @ $25 _
Application No. 3 7l{~
Permit No.
Applicant Namc ~;:?Al Y2t1. /f-~/4. "5T~,(} <.Ie.,
Applicant Mailing Address p d, 1=> 0 X / 4- ( 'L.
7.-7 J 'f'r-f d L- /7 ,N Y.
Septic Tank /or Cesspool_
Brief Description of Proposed Construction or Alteration
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Location of Proposed Construction/Alteration:
Owner of Property: r/ ' 13A- (VN
Owner Mailing Address: ::s 38 73 L. ,n; ""-1 f'C / ~t...p 5 T 11 ~ 1-
/1<')/5 t? 1< f;f-v _ ,/U.J, "';;,/50 - 4-8 z r::.
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60"(.) (/-1 c7f.-.O' /f/. </ II C; 7 (
Name and phone number of contact person C;;A/t",~;/ /J. 574-4"")
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O"11er Property Address:
Tax Map No: Section yo Block
Cross Street 50 v"'" P VI ~ -c;> A v€-.
b3(-7~J:-,,-f5)
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NOTE: LOCATION MAP MUST BE SUBl\fiTTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY H HEALm DEPARTMENT APPROVAL
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'Date
Si ature of Applicant
Received by: _~
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THIS sl'TE PLAN WAS PREPARED WITH INfORMATION TAKEN'FROM
A SURVEY MADE BY STANlEY J. ~. JR., UCINlEO LAN()8VRVEYOR,
NEW SUFFOLK, NliW YORK, DATED: MARCH 14, 20M
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SUPPOLKCOUNTYDEPARTMJ;NTUl' n="'U~-'" ---
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DAT~\.\~ () l.) 2G':Ji HSREF. o.IL 10 ~ 0 I ~ 00 n
APPR.OVED .
Wl OF ~BEDROOMS
EXPrRESTHREE YEARS FROM DATE OF APPROVAL
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