HomeMy WebLinkAboutLarsen, Ellen FF
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yO IW';, `C, ` Town Hall, 53095 Main Road
P.O. Box 728
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 8 , 1986
To: Victor Lessard, Southold Town Building Department
From: Judith T. Terry, Southold Town Clerk
Transmitted herewith is a copy of application No. 15 for a
CONSTRUCTION or ALTERATION Permit for a cesspool or sept c system
submitted by Richard Magill for Ellen Larsen
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
\Oc,VFFOCK�O
CONSTRUCTION �►
ALTERATION U"j
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RESIDENTIAL!
NON-RESIDENTIAL
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ to
DATE
APPLICANT NAME:
APPLICANT ADDRESS:
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION:
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
17
OWNER
OWNER ADDRESS: Ozo-cr-z
TAX MAP NO. : Section 6-'9— Block J Lot--�G
CROSS STREET: / �/-Lifi�f /14-4/615—
BUILDING
BUILDING PERMIT NO. CROSS REFERENCE:
c
Signature of Applicant
RECEIVED BY:
Town C rk's Office
DATE:
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