HomeMy WebLinkAboutLomangino, AnthonyELIZABETH 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
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO:
FROM:
DATED: August 3, 2010
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 3970
Permit submitted by:
Mark Schwartz for Anthony Lom~no~ino
Southold Town Building Department
Carol Hydell, 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.
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
Dated
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
Residential ~ $10
Applicant Name
Applicant Mailing Address
__ or Non-Residential ~ $25 __
Application No. ~ 5 7 -~
Permit No.
I ! q.3 ,F
Owner of Property:
Owner Mailing Address:
Septic Tank t/or Cesspool v~
Brief Description of Proposed (~onst~mction or Alteration
Location of Proposed Construction/Alteration:
Owner Property Address:
Name and phone number ofcontact person /~f~/~5 J~C'/7t~'/4~- 7""'~4
T~MapNo: Section I d ~ Block ¢ 3 ~t /6, ]
NOTE: LOCATION ~ ~ST BE SUBMITTED WITH ~PLICATION. NEW
CONSTRUCTION ~Q~S S~Y~~. ~ ~PROV~
~ ~ Silage of Applic~t~ Date
Received
by: