HomeMy WebLinkAboutO'Connor o��S�FFO(,�coG
ELIZABETH A. NEVILLE �� y� Town Hall, 53095 Main Road
TOWN CLERK d - P.O. Box 1179
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REGISTRAR,OF VITAL STATISTICS ry Southold, New York 11971
MARRIAGE OFFICER O,fi Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER "'/Ql �� 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: February 11, 2003
Transmitted herewith is a copy of application No. 3129 for a Cesspool/Septic Tank Construction
Permit submitted by:
Catherine Mesiano, Inc.
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:
Signature
Dated
ti
OFFICE OF THE TOWN CLERK
TOWNOFSOMOLD
ELIZABETH A.NEVUI,E,TOWN CLERK �OC��FFOIkcoG Application 114031a
P.O.BOX 1179 l O
SOUTHOLD,NEWYORK11971 = = Construction ✓
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Telephone O,f �
(631) 765-1800 $10.00 - Residential
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$25.00 - Non-Residential
TOWN OF SOUTHO.LD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: - if
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APPLICANT ADDRESS:
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: C
OWNER MAILING ADDRESS: SSU P
OWNER PROPERTY ADDRESS: S �
TELEPHONE NUMBER OF CONTACT PERSON: b:�) 878
TAX MAP NO. : Section_ b Block `t Lot Z • Z
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY: I
own Clerk's 0ffice
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OFFICE OF THE CLERK OF SUFFOLK COUNTY ON JUNE 21, 1990 AS Q
FILE NO. 8963. g;
• REFER TO FLOOD INSURANCE RATE MAP 3610300143 G �
LAST DATED MAY 4, 1998-
VERTICAL DATUM = N.G.V. DATUM (M.S.L. 1929)
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SURVEYOR'S CERTIFICATION = ccDZ Ci
• WE HEREBY CERTIFY TO LEONARD D,CONNOFt_-� AT11)
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THIS SURVEY WAS PREPARED IN ACCORDBYCTMWITH TMYo � TATE
PRACTICE FOR LAND SURVEYS ADOPTED
ASSOCIATION OF,PROFESSIONAL LAND SURVEYORS.
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