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HomeMy WebLinkAboutMoisa (4) ti / ' ® G otr: JUDITH T. TERRY Z Town Hall, 53095 Main Road TOWN CLERK : C b r f,'I C) FOL •' '/i1' /// , ' JUDITH T. TERRY ; i► Town Hall, 53095 Main Road TOWN CLERK ® P.O. BOX 1179 REGISTRAR OF VITAL STATISTICS VI ` • Southold, New York 11971 Fax Fax (516) 765-1823 MARRIAGE OFFICER ;_a, 1 ��®���' Telephone (516) 765-1801 ,Y• OFFICE OF THE TOWN CLERK ,4/, „ e TOWN OF SOUTHOLD '�` ,„, TO: Southold Town Building Department ,oz. ,� d` FROM: Linda Cooper, Southold Town Clerk's Office V DATED: April 12, 1994 �sip�E` 4>; �''�' Transmitted herewith is a copy of application No,4 1153 for a ALTERATION PERMIT for a cesspool or septic system submitted by Peconic Cesspool for Joe Moisa Jr. . 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 this office. Thank you. �Q(- ,, Linda J. Cooper * * * * * * * * * * * * * I have reviewed the application and location map of•the project listed above and make the following recommendation: APPROVE - EXCAVATION INSPECTION REQUIRED DISAPPROVE - COMMENTS: fr, , ,d, /Q S/4 41-0/ 4--/ c /� >.,/ ' 3E �� �, APR 1- (sr-/ I-t- Si•naf re / 1994 /-6. �,p kiwi Ci k souk, /��/ Date 71941, OFFICE OF "THE TOWN CLERK �, ,,,,,,,,," Town of Southold ��•'� c VULKep Application No. Judith i'. Terry, Town Clerk �OHO`.. Gy / Town Hall, 53095 Main Road Z ` - Contra_ction• P. 0. Box 1179 • % Southold, New York 11971 cpti ,� Iteratio • Telephone ` ,��0 - AC" $10.00 - Residential (516) 765-1801 .. 1 ,, •' $25.00 - Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ DATE e APPLICANT NAME: ,r fes` APPLICANT ADDRESS: /�/ / 2. - /1 SEPTIC CESSPOOL DESCR ' N OF PROP'SED ONSTRUCTION OR ALTERATION l . r e y / /��� - _v. LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRU . ION OR ALTERA.TION: OWNER OF PROPERTY: OWNER MAILING ADDRESS: d- r iete 17/017 OWNER PROPERTY ADDRESS: - TELEPHONE NUMBER OF CONTACT PERSON: TAX MAP NO. : Section /0 Block /0 Lot vZd v CROSS STREET: J/ BUILDING PERMIT NUMBER CROSS REFERENCE: Signature of Applic j RECEIVED BY: 4.44.cax„... • Town CI k's (90(117-13 DATE: L/' 1 �a