HomeMy WebLinkAboutSendlewski, Michael & Carol AnnELIZABETH A. NEVILr,F., RMC, CMC
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
TO:
FROM:
DATED:
RE:
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
December 29, 2008
Cesspool Construction Application
DEC %200
I
Transmitted herewith is a copy of application No. 3847 for a Cesspool/Septic Tank Construction
Permit submitted by:
Michael & Carol Ann Sendlewski
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
DISAPPROVE
Comments:
Signature
Dated
ELIZABETH A. NEVII,I,E
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.nor thfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 ~ or Non-Residential ~ $25 __
Applicant Name /~ ~'o~/lctd ~ ~/~ou~*[ frOr)
Application No. ~-~/-~
Permit No.
Applicant Mailing Address
Septic T~ or Cesspool
Brief Description of Proposed Cons~ction or Alteration
Owner of Property:
Owner Mailing Address:
Owner Property Address:
Location of Proposed Construction/Alteration:
Nme ~d phone nmber of contact person ~}~n
T~ Map No: Section t q ~ , Block
Cross S~eet ~/~ ~ o ~O
NOTE: LOCATION ~ MUST BE SUB~TTED ~TH ~PLICATION. NEW
CONSTRUCTION ~QUI~S SURVEY WITH HE~TH DEP~T~NT APPROV~
Silage of Applicm Date
Received by:
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