HomeMy WebLinkAboutBehringer, Michael -f '
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ELIZABETH A.NEVILLE og• �� y® Town Hall, 53095 Main Road
TOWN CLERK 4° � l® : P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICER % co Fax Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER •' ' 11 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER .1 southoldtown.northfork.net
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1`, s. 't"` , OFFICE OF THE TOWN CLERK
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TQ: Southold Town Building Department
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FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 21, 2007
Transmitted herewith is a copy of application No. 3772 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Latham Sand & Gravel for Michael Behringer
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED. .
Signature
Dated
114114CF°14''
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r~ TOWN �. Town Hall,59035 Mein Road
P.O_Box 1179
REGISTRAR OF VITAL STATISTICS mitSont$®ld,New York 11971
MARRIAGE OFFICERq(i' Fax(631)765.6145
RECORDS MANA IT OFFICER -'4%*
(' Telephone(631)765-1800
FREEDOM OF INFOR�ISATION OFFICER =
( southoldtown.a
orthfork.net
OFFICE OF THE TOWN CLERK
: TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 Y" or Non-Residential @$25 Application No. 3-17
Permit No. ?- ç13
Applicant Name "Ta.i, /46(e - , L t'Lcaw, Seunct Gcc i e(
Applicant Mailing Address P.O, ( o,c (.. , Pec-ev k,c A f Y JO S1F/
Septic Tank J/ar Cesspool ✓
BriefDescription of.Proposed Construction or Alteration D , e /ate shf;�( I�
anti Cc s�pnc�s '7 S (� � c T NP�ad+L. .ce- u i ce is- r c i
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Location of Proposed Construction/Alteration:
Owner of Property: Ai%��e, Age111,,,je j'
Owner Marling Aidress: QS- Cc�'F �cs_� act
$ CnG, j c7- 0480`7
Owner Property Address: /7 5:5 3110/`9
, WV //9YSi
Name and phone mer of contact person 'Sod h
1-4ecl<ef ?3Y-&Soo .
Tax Map No: 1000 Section 317 Block Lot 3 J
Cress Street S'i 1 veA-w•ei'€
NOTE: LOCATION MAP MUST BE SUSS WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY ' gHEALTH DEPARTMENT
�/ APPROVAL
/ `'t4,-1 . / 0.7
Si tura of Applicant Date
, Received ra •
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