HomeMy WebLinkAboutMautner ELIZABETH A. NEVILLE =�0 OGy� Town Hall, 53095 Main Road
TOWN CLERK H - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICERFax(631) 765-6145
RECORDS MANAGEMENT OFFICER y�pl �aO� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 24, 2002
Transmitted herewith is a copy of application No. 3019 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Gary Tabor
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
L
OFFICE OF THE TOWN CLERK `
Town of Southold C.��F ��' \
Judith T. Terry, Town Clerk Application No.____�
Town Hall, 53095 Main Road Construction
P. O. Box 1179
Southold, New York 11971 Alteration
Telephone 0,1�O� ��0� $10.00 - Residential
(516) 765-1801 $25.00 Non Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: J9
APPLICANT ADDRESS: Ze
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: 90676' ShDY' �
OWNER PROPERTY ADDRESS: rSlgs1-t c
TELEPHONE NUMBER OF CONTACT PERSON: CyO�c� dnlvly '�
TAX, MAP NO. : Section V Block_ _Lot
CROSS STREET :
BUILDING PERMIT NUMBER CROSS REFERENCE:
Si ature of Applicant
RECEIVED BY:
__ k—
a Town Clerk's Office
DATE:
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