HomeMy WebLinkAboutMcCarty, TheresaELIZABETH A. NEVILLE, 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.north fork.net
TO:
FROM:
DATED: July 30, 2012
Transmitted herewith is a copy of application No.
Permit submitted by:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building Department
Carol Hydcll, Southold Town Clerk's Office
lOW~
4098 for a Cesspool/Septic Tank Construction
Theresa McCarthy
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and 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:
APPROVE /
DISAPPROVE
Comments: ~
Dated
ELIZABETH A, NEVILLE "
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MAH,RIAGE OFFICER
REOQKDS MANAGEMENT OFFICER
FREEDOM OF II/FORMATION OFFICER
..Town Hall, 53095 Main Roa,
P.O. Box 1179
Soughold, New York 11971
Fax (831) 765-8146
Telephone (681) 765-1800
sou~holdtown,northfork.nel
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~ C)c~'
Permit No.
ApplicantName --~foez'-e3g2..~ .~r
Applie~t Maifing Ad.ess ~¢
Septic T~ ~r Cesspool
Brief Description ofPropo~d Consmction or Alte~tion
~cation of Propos~ Constmcfio~Mteration:
Owner of Properly: ~.f~
Omer M~g Ad,ess: ~q
O~er Prope~ Ad,ess: +
Nme ~d phone nmber of ~nmt person ~L~ ~CC~.r~ %Ir. ~ Zl-olo~
T~ Map No: S~tion
Cross S~eet ~ r~
NOTE: LOCATION ~ ~ST BE S~ED W~H ~PLICATION. NEW
CONSTRUCTION ~Q~S S~Y ~H ~TH DEP~T~T ~PROV~
of plic t
SUFFOLK COUNTY DEPARTMENT OF HEALTH S£RVICEI~ /
/
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
SINGLE FAMILY RE$15E. NCE ONLY
JUL 2 ~ 201~ , ~/.,_/~
DAT~ ~,.~, ~F. NO. ~U ~-~/
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icAbandonmem of existing sanitary system must be in
conformance with department requirement Submit
ompleted form WWM- ~0 as proofi