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Home My WebLink AboutJoint Industry Board of Electrical IndustryELIZABETH A. NEVII,I,F,, 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 sout holdtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: FROM: DATED: RE: Southold Town Building Department Carol Hydell, Southold Town Clerk's Office February 23, 2010 Cesspool Construction Application Transmitted herewith is a copy of application No. __ Permit submitted by: FEB 2 4 2010 BLDG. DEPT. TOWN OF SOUTIqO[D 3935 for a Cesspool/Septic Tank Construction Patricia C. Moore for Joint Industry, Board of Electrical Industry, 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 loca~n map of the project cited above and make the following recommendations: ~ APPROVE DISAPPROVE Comments: Final approval required from the Suffolk County Health Department Dated ~ -- ELIZABETH A. NEVILLE 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 SOUTHOLD WASTEWATER DISTRICT .APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential ~ $10 or Non-Residential ~ $25 / Applicant Mailing Addre-ss ~, ~OZo /27Ot752 //~67JOr / /I/'q . ~lq7/ Septic Tank or Cesspool Brief Description of Proposed Construction or Alteration Application No.~~L-~ Permit No. Location of Proposed Construction/Alteration: Owner Mailing Address: Owner Property Address: Name and phone number of contact person TaxMapNo: Section ~ Block ~ Lot Cross Street p62(~e NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY~H ~EALTH DEPARTMENT APPROVAL ~ture of Applicant Date Received by: 8affolk ~ Approval for ~on-~ ~No.~ / O.- P ~ ~ ,~.uwe~ ~r g~e~ ~n~ ~ ~o~ suppl~ ~d sewage disposal. Regardless ~is~acies or lack ~ (91 I ' , -, :