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ELIZABETH A. NEVILLE,MMC Town Hall,53095 Main Road
TOWN CLERK P.O. Box 1179
CIO Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631)765-6145
MARRIAGE OFFICER Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER ® 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: September 22, 2016
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4426 for a Cesspool/Septic Tank Construction
Permit submitted by:
Frederick Weber for Raymond & Ann Ramondi
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
ELIZABETH A. NE'VILLE Ze ��e Town Hall,58095 Main Rm
`T'O'WN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
Southold, New York 11971
MARRIAGE OFFICER Fax(691) 765-6146
RECORDS MANAGEMENT OFFICER Telephone(681)765-1800
FREEDOM OF INFORMATION OFFICER ®� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEP'T`IC TANK
Residential @$10 ;, or Non-Residential @$25 Application No. _a(o
Permit No.
Applicant Name
Applicant Mailing Address
Septic Tatzk__>�,_or Cesspool 4_
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:
- s � TC3
Owner Property Address: j 1
Name and phone munber of contact person � �� �w '
Tax Map No: 101_2 Section O Block Lot
Cross Street
NOTE: LOCATION MAP MUST 'BESUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUEPES8U7
T EP 'I' AI' IZOV
Si atnre of Applicant Date
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