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Home My WebLink AboutKatrazos, Themis & MariaELIZABETH 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 Fox (631) 765-6145 Telephone (631) 765-1800 southoldtown.northfork.net TO: FROM: DATED: RE: Carol Hydell, Southold Town Clerk's Office January 7, 2010 Cesspool Construction Application OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Southold Town Building Depmtment Transmitted herewith is a copy of application No. Permit submitted by: Robert C. Tast for Young & Young 3925 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. Carol Hydell I have reviewed the application and location map of the project cited above and make the following recommendations: / APPROVE DISAPPROVE Comments: Final approval required from the Suffolk County Health Department Signature ( ' F Dated ELIZA~JTtf A. NEV~I J,~ 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.nor th fork.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. Bl'M',,) Permit No. Applicant Name , ~ - Applicant Mailing Address .,~ ~_~~ ~'t~-" Septic Tank ~' or Cesspool Brief Description of Proposed Construction or Alteration Location of Proposed Construction/Alteration: OwuerofProperty:'~l~[~. 1[ MA,~tA ~.~-'f 1~~ Owner Mailing Address: ~:~ ~'f~.A'I'~'~,~ Owner Property Address: Name and phone number of contact person Tax Map No: 1 1/~ Section t~ Block ~ Lot ~ Cross Street ~t ~ I.~,~ ~t 123>~{ Vt~ NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW Si/mature of Applicant - - Date Received b'y: 51TE DATA AIR.EA = 41,41'~ .~. FT. N ~I'~UNTY~EPARTmT OF I RESIDENCE AND ~U~VEY(:::~, ~ ~,Et~TIFI~,ATION YEARS FROM DATE OF APPROVAL