HomeMy WebLinkAboutO'Reilly, ElizabethELIZABETH 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, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.north fork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO:
FROM:
DATED:
RE:
Southold Town Building Department
Carol Hydell, Southold Town Clerk's Office
October 15, 2012
Cesspool Construction Application
Transmitted herewith is a copy of application No. 4118
Permit submitted by:
Cy Keener for Elizabeth O'Reilly
for a Cesspool/Septic Tank Construction
Please review thc 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.
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE J
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
~LDG D[PT.
TOWI~ OF SOIJTHOLD
Signature
Dated
TOWN CLERK
REGISTBAR OF VITAL STATISTICS
IvIARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORiV~TION OFFICER
.flown Hall, 53095 Main Pos,
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtowmnorthfork.net
OFFICE OF THE TOWN CLERI~
TOWN OF SOUTHOLD
SOUTItOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 ~. or Non-Residential ~$25
Applicant Name_ Cx/ ~/~F.~.~"~.- '
Applicant Mailing Ac/dress ~>O
Septic Tank ~., or Cesspool
Application No. "6
Permit No.
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: 1~4.C~4x1~ O'~¢.~t.~'l~
Owner Property Address: 11420 /~',~ ~/:~li-
Name and phone nmnber of contact person C_..x/~
Tax Map No: Section ~ Block
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
~'~ffat~e of Applicant ' bate