HomeMy WebLinkAboutPufahl, CarolELIZABETH A. NEVII.I.E~ RMC, CMC
TOWN CLERK
REGISTRAII 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:
DATED:
OFFICE OF THE TOWN CLERK
·
Southold Town Building DeparOnent
Carol Hydell, Southold Town Clerk's Office .~ ]
June 16, 2009 . ~
RE:
Cesspool Construction Application
Transmitted herewith is a copy of application No. 3880
Permit submitted by:
Andrew J. Schmitz III, AIA for Carol pufahl
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 return it to me. Thank you.
I have reviewed the apPlication and location map of the project cited above and make the following
recommendations: 1~~
APPROVE
DISAPPROVE
Comments:
Signature
Dated
ELIZABETH A. NE~,LE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
Town Hall, 53095 Maln 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
Residential ~ $10 / or Non-Residential ~ $25
Application No.~__~_~ (~)
Permit No.
Applicant Mailing Address
S~fic T~ / or Cesspool
B~ef Description of Propos~ Com~ction or ~t~fion
~c~ion of Proposed Co~ctio~Altemfion:
Omer of Pmp~: ~.~[
Om~ M~l~g Ad&ess:
O~er Prop~ Ad&ess:
Nme phone nmb Of con t p on
T~ Map No: S~tion
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signature of Applicant //~ Date
Received by:
10'
11'
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