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Campo, Anthony
��� F�Ot � �I�IZE���T$I A. I�IEVII.LE+,IVIIVIC � Town Hall,53095 Main Road �����I���� � P.O. Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS �° � Fax(631)765-6145 MARRIAG�OFFICER � Tele�hone(631)765-1800 R�CORDS MANAGEMENT OFFICER �� � www.southoldtownny.gov FREEDOM OF INFORMAIION OFFICER ������ ����� ���� �I.�' � TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Carol Hydell, Southold Town Clerk's Office DATED: September 8, 2016 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 4421 for a Cesspool/Septic Tank Construction Permit submitted by: Anthony Campo . 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 tne. Thank you. * * �: � � � � * � �: * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: Final a�proval required from the Suffolk CountX Health Department Signature Dated - o�asu��o�,�co ELIZABETIi A, NEVILLE e `� . ... � G�G - �Town Hall, G3096 Main i3,oa� � . TOWN CLERK y :� ; PA. Box 1179 REGISTR.AR OF VIT.AL STATISTICS �, m Southald, New Ynrk 11971 MARRIA4E OFFICER � � `�' Fax (631) 766-614� RECORDS MANAGEMENT OFFICER ��fo� � ��0� Telephone (631) 765-1800 FREEDOM OF INF02ZMATION OFFICER southoldtown.northfork.nef � OFFICE OF THE TUWN CLERI� .� TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT - APPLICATION CONSTRUCTIOI� or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 or Non-Residential @$25 Application No. �'�� �J Permit No. Applicant Name �� �� ��� Applicant Mailing Address �_�� � �1,�� � � _. _ �� Septic Taz�lc. or Ces pool Brief Description of Proposed Construction or Alteration Location of Proposed Construction/.Alteration: � _� Owner of Property: G �-f ° � � Owner Mailing Address: �' � �� � � ' � ���� � . � � ��i�������--���/'��f�� Owner Property Address:��,������`�`�;,�t��,�,� d� �, y- �� ��^����_���� ��,: ., � ''�:`��g��t�- m Name and phone nuznber of contact person , �� ��� , �.�� ���- a��. ���� �� � Tax Map No; Section � � ;, Block �(�____ I:,ot �--;.�.�� r Cross Street I�OT�e I.C�Cf1T�ON 1�I�7S'I' �� SLTI3Il�II�"I'ED �'�k-I AI'I'LICA.'I'IOI�I. 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