HomeMy WebLinkAboutMoczulska ELIZABETH A. NEVILLE,MMC 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 �� Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER "'»,�_ ass. www.southoldtownny.gov
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: July 22, 2016
Transmitted herewith is a copy of application No. 4410 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Barbara Moczulska
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and 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: Maintain required setbacks from adjacent wells, buildings, property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signature
Dated
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Permit No.
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