HomeMy WebLinkAboutDavis, Janet • ,•e�®cpF sot/4y% -
ELIZABETH A.NEVILLE ® Town Hall, 53095 Main Road
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TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ; G
Southold
New York 11971
MARRIAGE OFFICER . �� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER c`• Telephone,, oil Telephone (631) 765-1800
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FREEDOM OF INFORMATION OFFICER ouNTY+ ��0fsoutholdtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3549 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JANET A DAVIS
Address 1: PO BOX 1604
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
REPLACE EXISTING OLD BRICK CESSPOOL.
MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS,BUILDINGS,PROPERTY LINE
S AND WATER BODIES.EXCAVATION INSPECTION REQUIRED.
Name Of Owner SAME AS ABOVE
Mailing Address 1
City St Zip 0000
Property Address 1 45395 MAIN ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 75.00 block 2 lot 1.100
Cross Street MAPLE LANE
Building Permit Number Cross Reference:
Issue Date: 6/12/07 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE $ '`. l0
,� Town Hall, 53095 Main Road
TOWN CLERK ; * * P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ; G Q ,�
Southold, New York 11971
MARRIAGE OFFICER ; - •1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `;�lij'C �`^�'0•
' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER Ou 1 `�►(�,`�� southoldtown.northfork.net
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OFFICE F- rs _.(n,'- \ ' I '— '
OF THE TOWN CLERK : ; ;
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TOWN OF SOUTHOLD - '
MAY - - t,
TO: Southold Town Building Department ; ' ,,,.,;,-:
FROM: Michelle L. Martocchia, Southold Town Clerk's Office
DATED: May 8, 2007
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 3705 for a Cesspool/Septic Tank
Construction/Alteration Permit submitted by:
Janet A. Davis .
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. Thank you.
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE _ ,�
Comments: '� • .Q �'""�'
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Signature
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Dated
II o•ii OFfU�,�
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ELIZABETH A.NEVILLE ����`Z` OGy�� Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
t ti Z Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
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is
OFFICER
O Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ;y?f %�- Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER 491jig *G-010 southoldtown.northfork.net
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 NQ3105
Permit No. 35 Li 01
Applicant Name . `bee vi S
Applicant Mailing Address iPO C‘ a 4
S o d KL ``, c l y 7 /
Septic Tank or Cesspool x _C
Brief Description of Proposed Construction or Alteration /Q.. r`li e e .,s /, i 6,1
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Location of Proposed Construction/Alteration:
of Property: a_,� P�6 A-
Owner Mailing Address: e D / 6 v y
°Id NV /l y 7 /
Owner Property Address: .93 3
5--)0 Lid id
MV
Name and phone number of contact person J �,t�-�� � �/i S 73 V—J a 7
Tax MapWal S' Section
7\r Block 02__ Lot //
o:
Cross Street Pr ►ze C tôtp/
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
1,0� 4 a . „Da...„,_ • 1 7 /0 7
gnature of Applicant Date
Received by: '”. ,
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