HomeMy WebLinkAboutFlotteron, JosephELIZABETH A. NEVILLE, RMC, CMC
TOWN CLERK
REGIS ~fB. AR OF VITAL STATISTICS
MARRIAGE OFFICER
RE(20t:~I)S MANAGEMENT OFFICER
FREEDC) ~I OF INFORMATION OFFICER
Town Hail, 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: November 23, 2009
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 3914
Permit submitted by:
Fred V~eber for Joseph Flotteron
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
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.
APPROVE
DISAPPROVE
Comments:
I have reviewed the application and location map of the project cited above and make the following
recommendations: /
S,gnature
Dated
ELIZABETH A, NEVILLE ~-'
TO'WN CLERK
REGISTHAR OF VITAL STATISTIC8
M~KKIAt~E OFFICER
RECORDS MANAGEMEN~ OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF 8OUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
.~Town Hall, 63095 Main Res
P,O. Box 1179
Southold, NewYork 11971
F~x (631) 765-6145
Telephone (631) 765-1800
sou tholdtown.northfork.ne~
Residential ~ $10 ~X~ or Non-Residential ~$25
Application No~ ~//~/~
Permit No.
Applicant Name ~
Applicant Mailing Address
Septic Tank ~<~ or Cesspool
Bri.e~f Descrip_tion of Proposed Construction or Alteration
Owner of Property:
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person ~
TaxMapNo: [000 Section 1[~::~ Block O~... Lot I'~.1 _
Cross Street l[& t ISBV. '
NOTE: LOCATION MAP MUST BE SUBMITTED WITIt APPLICATION. blEW
Sig~atu~ of Applicant Date
NOTE CHANGEIS)
~ by Dept. of Health Services
N
20
o~v
~zO~'O
) MUST Be Inspected
th:
852-5700, 48 Hours In Advance,
To Schedule Inspection(s).
SITE PLAN
FREDERICI( WEBER, ARCHITECT
EAST HAPLE ROAD
GREENLALLIN. NY 11'140
OCTOBER Iff. 200fl
OCTOBER 22, 200fl
FLOTTERON RESIDENCE
5~5 CLEARtUATER LANE
CLITCHOGUE, NEIU YORK.