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ELIZABETH A. NEVILLE,MMC I N€ Town Hall,53095 Main Road
TOWN CLERK '„ P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS `' Fax(631)765-6145
MARRIAGE OFFICER 4, . Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER a _' www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: June 29, 2016
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4399 for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Cesspool for Mary Korpi
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: Final approval required from the Suffolk County Health Department
Signature
Dated
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SOUTROLD WASTEWATER DISic�
CONSTRUCTION or ALTERATION T
CESSPOOL or SEMICT
' $2 ApplicationNo. .
Residential @$10 _® or ion R de Permit No-
Applicant Name
PB TC CESSPOOL
Adder p• O. Bn
Applicant Mailing.
Address
LAITREL, N Yon. 11948
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