HomeMy WebLinkAboutBendick, John
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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
J~\'-\ 2. 8 '
l OFFICE OF THE TOWN CLERK
...i
TOWN OF SOUTHOLD
TO:
Southold Town Building Department
FROM:
Carol Hydell, Southold Town Clerk's Office
DATED:
January 28, 2008
RE:
Cesspool Construction Application
Transmitted herewith is a copy of application No. 3773 for a Cesspool/Septic Tank Construction
Permit submitted by:
John & JaCQueline Bendick
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.
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I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
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DISAPPROVE
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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
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Applicant Name J~> Ii n <1,7,: c 0" "'r // n t"
,
Applicant Mailing Address 800 Cbt/rl/JC/ y.rA
Uvtc It (JCi /(;Y /( '13S't..
Septic Tank_or~l~
Brief Description of Proposed Construction or Alteration
N.ew- /r"C'c.:df,.!r(..X "en "L clu),-ttt;J
I .
Location of Proposed Construction! Alteration:
Owner of Property: /) e/1d'...e.lc..
Owner Mailing Address:
Application No. 377 3
Permit No.
Oe.nc/t c' k
Rc,ad', I'-Dt3ox 739
Residential @$JOA or Non-Residential @ $25_
Owner Property Address:
Name and phone number of contact person
Tax Map No:
Cross Street
Section / / /
Block C:>
Lot / /
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVE:XWI1:~HEALTH DEPARTMENT APPROVAL
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Received by: