HomeMy WebLinkAboutLemler 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
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department �cmc wm
D
FROM: Sabrina Born, Southold Town Clerk's Office APR - 5 2017
DATED: April 5,2017
'BUIL-DU 0I LW-
RE: Cesspool Construction Application TOWN OF S®UTH®LD
Transmitted herewith is a copy of application No. 4472 for a Cesspool/Septic Tank Construction
Permit submitted by:
Erich Schoenenberger for Jeff&Anca Lemler
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
V
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department.
Signature
Dated
It
Of
��SUFFot,��,
ELIZABETH A.NEVILLE �`L`® ®G�. Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
CIO
2 Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER
MARRIAGE OFFICER ®efe ® � Telephone (631) 765-1800
�Q1 ��
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD RECEIVED
SOUTHOLD WASTEWATER DISTRICT
APR - 42017
APPLICATION
Southold Town Clerk
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 ;k or Non-Residential @ $25 Application No.LI LI7 2,
Permit No.
Applicant Name jg:RIGfF
Applicant Mailing Address N ORE* I(1�ff' q1—. 13rznngw. Wy
i Eos
Septic Tankor Cesspool
Brief Dgscrip ion of Proposed Construction or Alteration hjLCtu QjAIG Lit- f F] i _
Location of Proposed Construction/Alteration:
Owner of Property: FF �lC LtM4 L��2
Owner Mailing Address: /0 L- '!!�-3 Ruo G7. ss of
toy toy IOC7 g
Owner Property Address: 3 2,0
111K C eel G 'y
Name and phone number of contact person 9�
Tax Map No: Section a Block� Lot�_
Cross Streeter O ,A;T
NOTE: LOCATION MAP MUST B— 5 11 TED ITH APPLICATION. NEW
CONSTRUCTION REQUIRES S EY WIT AL TMENT APPROVAL
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Signature of A licant D66'
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FOLK COLNrf DZIPARTMENT OF HEALTH SER
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