HomeMy WebLinkAboutBosworth, RichardAPR 29 2909 ,
TOWN OF SOUTHOLD
TO:
FROM:
DATED:
RE:
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
April 29, 2009
Cesspool Construction Application
Transmitted herewith is a copy of application No.
Permit submitted by:
Richard Bosworth
3871 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 l~elow 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 J
DISAPPROVE
Comments:
Signature
Dated
ELIZABETH A. NEVILLE ''
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MAKKIAGE OFFICER
RECORDS IvlAIqAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Residential ~ $10 / or
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTEILATION PERMIT
CESSPOOL or SEPTIC TANK
Non-Residential (~ $25
.,,Town Hall, 53095 Main Res
P.O, Box 1179
Southold, New York 119 71
Fax (631) 765-6145
Telephone (631) 765-1800'
sou tholdtown,nort, hfork.ne,
Penni!
ApplicantNa~$ /~/~I/.4~ Z037tl/O/L"~/
Applicant Mai~ng Ad~e~s. ~O Z~ ~/~ ~y ~Z~. ~~//2~
Scl)tic Ta~ ~or Cesspool
Brief'Description ;f Proposed Construction or Alteralion~ ~~
~cation of ProposM Constructioiff~tcration:
Owner of Property: ~~ ~d~
Nam e mrd P ho n e Ir un'lb er o f co ntact p er son_j~/r_14,~,,~/3_ ..gi/O/~,.~*/
TaxMapNo: Section/ri7 .Block__~_ Lol
NOTE: LOCATION ~ ~ST BE 8UB~TTED W~It ~PLICATION. NEW
CONSTRUCTION ~Q~8 8~Y ~H ~TH DEP~T~NT ~PROV~
Si~a~~t Date
R~iv~ ~