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ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREl'DOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 1197I
Fax (631) 765-6145
Telephone (631) 765-1800
southold town. northfork. net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO:
Southold Town Building Department
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED:
June 29, 2007
Transmitted herewith is a copy of application No. 3721
Permit submitted by:
for a Cesspool/Septic Tank Construction
East End Construction Svcs. Inc
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
Comm~" _~q}%1;f~~
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Signature ~
/o/5.S-~7
Dated I /
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
south~ldtown.noI:thfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CO~STRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10~ or Non-Residential@$25_
Application No~ 7;)-l
Permit No.
ApplicantName C:.<3:rJo Cd.Jrlil.PCA-wJ ~CJ7 rt>J'--
Applicant Mailing Address /JD i.!>'H(xV/("J rOA--- ~<lTN[~h
I (or, I
Septic Tank_or Cesspool K
Brief Description of Proposed Construction or Alteration l)cL<.o"S~ ANa A/l.AAlOO,J
C'Xld fIN \. HocU,,'... Ct~('f'u"'- - t2c .~LAC.~ WIn. A.lci:J
Location of Proposed Construction! Alteration:
Owner of Property: &Of.l, 0~
Owner Mailing Address: ~7:S- 6.J)( L.,J
Owner Property Address:
119J~
Cu. 1u.J. () (.u';-
J''''......r--
Name and phone number of contact person
Tax Map No: J().f) Section '1 &,
Cross Street MAI,J ~.
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Received by:
~"rA~....(
Block
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3
Lot t. I
CUTCHOGUB
TOWN'OF SOUTHOLD
SuFFoLK COUNTY, NEW YORK
SUFFOLK COUNTY TAX II 1000 - '16 - 3 - 1.1
OWNER -APPIJCANT:
LEANDER B. GLOVER
COX'S LANE
CUTCHOGUE, NY
MAP PREPARED, 01-13-03
AMENDED. 03-24-03, 08-06-04
SCHOOL DISTRICT. IIq
FIRE DISTRICT, 112q
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GRAPHIC SCALE
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mFFOLK COUNTY DEPARTMENT OF HEAL TIi SERVIC
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