HomeMy WebLinkAboutHillenbrand, Alex ,,�,,o�oOFFOt�/O
ELIZABETH A.NEVILLE,MMC �h0 `_G.j,• Town Hall,53095 Main Road
TOWN CLERK % ; P.O.Box 1179
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Z Southold,New York 11971
REGISTRAR OF VITAL STATISTICS : ��
O � � Fax(631)765-6145
MARRIAGE OFFICER \'*4. 0�1 Telephone(631)765-1800
RECORDS OF MANAGEMENT OFFICER �! * "Vs southoldtown.northfork.net
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Carol Hydell, Southold Town Clerk's Office
DATED: May 2, 2012
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4082 for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Cesspool for Alex Hillenbrand
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:
Signature
Dated
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.1ZABE1'S A.rurniza i Town Hai,53095 Main Road
TOWN C P.O.Boa 1179
REGISTRAR OPVITAL STAT GS Southold,Nei*Turk 11971
MAF At R OFFS _= - t Paz(631)765.6146
RECORDS MANAGEMENT o Te apbone(631)765-1800
FEZEDQ3L OP 3NPOZICA1ION s•' soak et
OFFICE OF THE TOWN CLERK
• TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
. APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
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Resided Qa $10or Non-Resi ®$25 Application No. H
PrtitNo.
Applicant Name PE IC CESSPOOL
Applicant Mailing Ad ss P• 0. BOX_487
LAUREL, NEW YORK 11948
Septic Tam-!_or Cesspool
Brief '-• ;'�3*=,�of' •.1.•,-• •,•-ii :a .r • t,(• Alt�$j• ,
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Location of Proposed.Construction/Alteration:
Ownerof Plea Ht1ei'tbrc,n
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Owner Mailing Address:
Owner Address: 5th L(ti VI ro% Pot (-1LIC ifroA613\
.4, ,. N tl 95-ct F-R)
Name and phone of contact person 3l�` 13 " l-eA
Tax Map No: Sectio S II. Lot a3
CrossStreet ci
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NOTE: LOCATION-MAP MUST BE • $ : .1 r • WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SUR WITH v TSI DEPAR RVAL
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