HomeMy WebLinkAboutShannon, A c�UFFOtk 11
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P.O. Box 728
1 Southold, New York 11971
JUDITH T.TERRY TELEPHONE
Town CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
August 4 , 1986
To: Victor Lessard, Southold Town Building Department
From: Judith T. Terry, Southold Town Clerk
Transmitted herewith is a copy of application No. 12 for a
CONSTRUCTION or ALTERATION Permit for a cesspool or septic system
submitted by Richard Magill for A. Shannan
Please advise if the project has received Suffolk County Health
Department approval and if we may issue the permit .
Judith T. Terry
Southold Town Clerk
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Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
JUDITH T.TERRY TELEPHONE
TOWN CLERI:
(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
August 4 , 1986
To: Victor Lessard, Southold Town Building Department
From: Judith T. Terry, Southold Town Clerk
Transmitted herewith is a copy of application No. 12 for a
CONSTRUCTION or ALTERATION Permit for a cesspool or septic system
submitted by Richard Magill for A. Shannan
Please advise if the project has received Suffolk County Health
Department approval and if we may issue the permit .
Judith T. Terry
Southold Town Clerk
Attachments
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OFFICE OF THE TOWN CLERK O�jVFF�G�' 0
Town of Southold - �� C� Application No./��
Judith T. Terry, Town Clerk ..�
Town Hall, 53095 Main Road Construction
P. 0. Box 1179 p • Alteration
Southold, New York 11971
Telephone Olt Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ A �= /
DATE C G�
APPLICANT NAME: _g/�L-��� � C( -
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: 0099�i Szo�_Aj IA_z/
OWNER MAILING ADDRESS: Lj��r
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: C Jy
TAX MAP NO. : Section 12,5 Block Lot /S
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE: �—
Signature of App cant
RECEIVED BY: - �-
'Town Cler s Office
DATE:
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