HomeMy WebLinkAboutTagios, John SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
{~kResidential ~ $10 Non-Residemial ~ $25
Application No.
Applicant Name:
Applicant Mailing Address: ~=',o, q>o?< ~ -3
Sep,ic = mr Cesspool 7
Permit No. ~
Brief description of Propsed Construction or Alteration:
Location of Proposed Construction/Alteration:
Owner of Property: -~g~t4,o
Owner Mailing Address:
Property Address: 7S'zp "~o ~ ~o,,atv-~--r3 ~oq,,o ~
Name and Telephone No. of Contact Person:
Tax Map No.: ]0cO Section: 7(-~ Block: (2)~ Lot: _'g~3'''~
Nearest Cross Street: -V3~J ~o~'~r~--o ~ ~~ ~
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUI~S SURVEY W~H HEALTH DEPARTME~ APPROVAL.
Si t Date
Received by:
ELIZABETH A. NEVILLE, 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
TO:
FROM:
OFFICE OF THE TOWN CLERK
TOWN OF $OUTHOLD
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
FEB 2 5 200
BLDG. DEPT.
TOWN OF SOUTHOLB
DATED: February 24, 2009
RE:
Cesspool Construction Application
Transmitted herewith is a copy of application No.
Permit submitted by:
Frank Notaro
3857 for a Cesspool/Septic Tank Construction
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and retum 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