HomeMy WebLinkAboutFerguson, John ELIZABETH A.NEVILLE,MMC Town Hall,53095 Main Road
TOWN CLERK o P.O. Box 1179
CA Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631)765-615
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: December 27, 2016
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4453 for a Cesspool/Septic Tank Construction
Permit submitted by:
John FerjZuson
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:
Signature
Dated
�G
)rLI7.A.BETi3 A. NEVILLE �� �� Town Hail, 63096 Main Roa
TOWN CLERK tz
to _ P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS tiy.
MARRIAGE OFFICER ` Fax (631) 765-6146
RECORDS MANAGEMENT OFFICER ��fQ �OTelephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER '� �` southoldtown.northfork.nef
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTROLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANI{
Residential @$10 or Non-Residential @$25 Application No. � 3
Permit No.
Applicant Name_ � �,�' S
Applicant Mailing Address t")eA y
Septic Tank. or Cesspool
Brief Description of Proposed Construction or Alteration
_ C` moo✓ � 4-^'.S'�
Location of Proposed Cons truction/Alteration:
Owner of Property:_ is
Owner Mailing Address: t„ d
Owner Property Address:
Name and phone number of contact person
Tax Map No: Section Block Lot—
Cross Street
NOTES LOCATION MUST BE SUBAUTTED WITH APPLICATION. NEW
CONSTRUCTION RE'QUIRES SURVEY H FIEAL +PANTNTPR VAL
Si. ature of Appl ant Da e
Received by:
•
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