HomeMy WebLinkAboutNorklun, StaceyELIZABETH.6, NEV~J,E~ MMC
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS OF MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, NewYork 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
TO:
FROM:
DATED:
OFFICE OF THE TOWN CLERI4
TOWN OF SOUTHOLD
Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
September 8, 2011
Transmitted herewith is a copy of application No. 4039
Permit submitted by:
for a Cesspool/Septic Tank ALTERATION
Peconic Cesspool for Stacey Norklun SCTM #70-8-12
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.
I have reviewed the application and location map of the project cited above and make the following
recommendations: j
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings, property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signature
Dated
REC, mTRAR OF VITAL STATISTICS
~ OFFIC~a
~ OF ~)~ATION OFFICER
Town H_;_n~
P.O. Box 1.1.79
Southold, NewYork ~.1971
Fax (651) 76~614.5
Telephone (631) q65-1800
OFFICE OF THE TO~ C~.~:i~K
TOWN OF SO~THOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PER.MIT
CESSPOOL or SEFIIC TANK
,~n~'~u~IO REOUIR~ SURVEY WITH HEALTH DE~ ~
Si~~t ~ v ~ Date
~ OF ~;NFOI~TION
Town H_-I~ ~095 Ms/n Road
P.O. Box
/~uthold, NewYork
OFFICE OF T~E TO, TN
TOWN OF SoUTHOLD
SOUTftOLD WASTEWATER DISTRICT
CONSTRUCTION or ALTERATION ~ERMIT
CESSPOOL or SEFTIC TANK
- P,-~:t No.
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