HomeMy WebLinkAboutBrennan, Mary 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 ® www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
FFICE OF THE T CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: October 19, 2016
Transmitted herewith is a copy of application No. 4437 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Morris Cesspool for Mary Brennan
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
ELIZABETH A. NEVILLE & Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
CA Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
Fax (631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER ��f�� ��� Telephone (631) 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 SEPTIC TANK
Residential @ $10 or Non-Residential @ $25 Application No. /
Permit No.
Applicant Name
Applicant Mailing Address 46k
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration J e b lz "Oct C2%-n_40_A/
Location of Proposed Construction/Alteration:
Owner of Property: @ Y
Owner Mailing Address: Z5- 7
Owner Property Address:
Name and phone number of contact person
Tax Map No: Section _Block Lot
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signature of Applicant Date
Received by:
job
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