HomeMy WebLinkAboutToth, VickiELIZABETH 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.northfork.net
TO:
FROM:
DATED:
RE:
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
September 28, 2012
Cesspool Construction Application
SEP 28 2012
BLDG DEPT.
TOWN OF SOUTHOLD
Transmitted herewith is a copy of application No.
Permit submitted by:
Vicki Toth
4112 for a Cesspool/Septic Tank Construction
Please review the application and location map and advise if this office may issue thc permit.
Please complete the form below and return it to me. Thank you.
I have reviewed the application and location map of the project cited above and make the following
recommendations: ~
APPROVE
DISAPPROVE
Comments: Final approval required fi.om the Suffolk County Health Department
Signature
Dated
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
~Residential ~ $10 or [] Non-Residential ~ $25
Application No. L~flI e~
Applicant Name: [/[ g-g--~
Applicant Mailing Address: ~/Oq,.~ .~/q~E~) ~
Brief description ofPropsed Const~ction or Alteration: ~
Septic Tank [] or Cesspool
Permit No.
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:
mrope~ Address:
Name and Telephone No. of Contact Person:
T~ Map No.: Section: ~ ~ Block: / Lot:
Nearest Cross Street:
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEP~MENT APPROVAL.
fl~ Sig~ture of Applic~t Date
Receiv~
by:
/
/
MAP OF PROPERTY
AT
BA YVIEW
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N Y.
1000 - 88- 01- 1.5
Sca/e: 1" = 50'
June 28, 2012