HomeMy WebLinkAboutThirlby, Ted ,rolfF
ELIZABETH A. NEVILLE,MMC Town Hall,53095 Main Road
TOWN CLERK P.O. Box 1179
CA at 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: November 7, 2016
Transmitted herewith is a copy of application No. 4444 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Latham Sand & Gravel, Inc. for Ted Thirlby
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
��oSUFFot,(�o
ELIZABETH A.NEVHJZ �`L` G�� Town Hall,53095 Main Road
TOWN CLERK p P.O.Box 1179
ce Z Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER O� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER t southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERAM
CESSPOOL or SEPTIC TANK
Residential @$10-2—< or Non-Residential @$25 Application No.
Permit No.
Applicant Name JON-) Jn C�_
Applicant Mailing Address
Septic Tank or Cesspool
Brief Description of Pro osed Construction or.Alteration SW f c: -L> c 5
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Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address: 1 I E -rrj(I,0 i3O)A V-0 _ —
ulhc;Id &J 9 r 19•� I
Owner Property Address: !:52, n-)Q MS F)L 0Z-1
Name and phone number of contact person ") 40C Of 734- 6 0
Tax.Map No: l Section Block Lot
Cross Street / 2ne. ri C
NOTE: LOCATION NMY NIUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIURES SURVEY P NT APPROVAL
Signature of Applicant Date
Received by:
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