HomeMy WebLinkAboutHeidtmann, Glenn V, 0
ELIZABETH A. NEVILLE,MMC Town Hall,53095 Main Road
TOWN CLERK a P.O. Box 1179
CA 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 TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: October 21, 2016
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4439 for a Cesspool/Septic Tank Construction
Permit submitted by:
Glenn Heidtmann
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
gF
ELIZABETH A. NEVILLE Town Hall, 53095 Main Road
TOCLERK F.O. Box 1179
Southold, New York 11977..
REGISTRAR OF VITAL STATIS`rICSFax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICE � Telephone (631.) 765-1800
FREEDOM OF INFORMATION OFFICER �� southoldtown.northfork.net
OFFICE OFT TOWN CLERK
TOWN OF SOUT11OLD
SOUTHOLD WASTEWATER 3ST CT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10_- or Non-Residential @$25 Application No.
Permit No.
Applicant Narne 6,11,tnn,
Applicant Mailing Address_ •D ba �4_h 2---9 aaVIvZeQ 2L
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alterationoll Stvv NI"',)2
Location of Proposed Constniction/Alteration:
Owner of Property:.__...— (c Vl U1.
t
Owner Mailing Address:__.__
Owner Property Address: ell ( f�
Name and phone number of contact person
Tax Map No: I r.,PL) Section `_70 Bloch �_'_`�....__. Lot.._..._�
Cross Street
NOTE: LOCATION MAP MUST T E SUBMITTED WIT1.1 WITAPPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
9 /
. _.....__.._.—_._...._._....._._...........I �_.1..�.. .._.__
Signature of Applicant Date
Received.by: . .__. _.__.
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