HomeMy WebLinkAboutWood, Tim (2)ELIZABETH A. NEVII.I,~ 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: October 31, 2008
Transmitted herewith is a copy of application No.
Permit submitted by:
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
3835
Tim Wood
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me.
Carol Hydell
I have reviewed the application and location map of the project cited above and make the following
recommendations: ~
APPROVE
DISAPPROVE
Comments:
Maintain required setbacks from adiacent wells, buildings, property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
/
Dat ed/'~"'~//~/~/Q
ELIZABETH A. NEVILLE '"
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS iV~d~AGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
..Town Hall, 53095 Man
P.O. Box 1179
Southold, NewYork 11971
Fax (631) 765-6145
Telephone (681) 765-1800
southoldtown.northfork.nel
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 C~$25
Application No. 3 ?,_~-J~
Permit No.
Applicant Name T I ~ V~/C)OI~
Applicant Mailing Address .~,~. ('~ [~D ~0~ ~
Septic T~ or Cesspool ~
Brief Description of Proposed Cons~ction or Alteration
Location of Proposed ConstructiovJAlteration:
Owner of Property:
Owner Mailing Address:
Ova~er Propet~:y Address:
Name and phone number of contact person I']~. ~ .A,OOOO - ~i~ f- 7~' "/~ ~,
TaxMapNo: [000 Section ~;~..~ Block '~' O~ Lot 2G _
Cross Street ./~.,~AJ .]~,.O_,~D
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION, NEW
CONSTRUCTION REQUIRES SURVEy WITH HEALTH DEPARTMENT APPROVAL
~ ~~gnature of Applicant
l~ecoiv~d I~y t ~ / .
Date
" ''-- ~' (PROPO$~D ADD/
LOT 25
~/o ~ '.
LOT 2~ ~. ~
s T Y ~
GRAVI~L
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