HomeMy WebLinkAboutCCG Bayberry ELIZABETH A. NEVILLE,MMC Town Hall,53095 Main Road
TOWN CLERK a 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.southoldt:ownny.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: January 4, 2017
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4455 for a Cesspool/Septic Tank Construction
Permit submitted by:
Charles Thomas for CCG Bayberry
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
� ®j�c�
ELIZABETH A.NEVILLE 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
RECORDS MANAGEMENT OFFICER ®� �� 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 Zor Non-Residential @ $25 Application No.
Permit No.
Applicant Name
Applicant Mailing Address 7c
Septic Tank_]_or Cesspool
Brief Description of Proposed Construction or Alteration CN? i0
Location of Proposed Construction/Alteration: Q
Owner of Property:
Owner Mailing Address:
ejo
Owner Property Address: (:P
Name and phone number of contact person
Tax Map No: Section Block Lot a
Cross Street F.F
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH AL DEPARTMENT APPROVAL
Sig e of Applicant Date
Received by: .
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