HomeMy WebLinkAboutF&S LLC ELIZABETH A.NEVILLE,MMC ®� ���j Town Hall,53095 Main Road
TOWN CLERK �� �� P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS A Fax(631)765-6145
MARRIAGE OFFICER ,f. ®�. Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER ��,` �� www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
7
TO: Southold Town Building Department APP 1 0 2017
FROM: Sabrina Born, Southold Town Clerk's Office BUII,DEWO Dom.
DATED: April 7, 2017 TO WNOF SODUTHOLD
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4474C for a Cesspool/Septic Tank Construction
Permit submitted by:
F& S,LLC
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 Departmentb
Signature
Dated
•1
O
ELIZABETH A. NEVILLE �`Z� �¢r Town Hall,53095 Main Roa.
TOWN CLERK A P.O. Box 1179
REGISTRAR.OF VITAL STATISTICS
Southold, New York 11971
MARRIAGE OFFICER Fax (631) 765-6146
RECORDS MANAGEMENT OFFICER y��� ���� 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 or Non-Residential @$25X Applicationvo.
Permit No. Qn-1 —�
Applicant Name S LLC
Ap licant Mailing Address 5-39
Septic Tank. or Cesspool
Brie Description of Proposed Construction or AlterationMew CQ _S r�rPr�
_ �
Location of Proposed Construction/Alteration:
Owner of Property: S i L.L-�Ci�
Owner Mailing Address:
Owner Property Address:
bc
Name and phone number of contact perso�a M Itt-ev & 1 3(0q 0
Tax Map No: Section ® Block O 0-5 Lot
Cross Street
NOTE: LOCATIO MAP MUST SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES S �7
lature
WIT ALTH DE - TMENT APPROVAL
of Applicant ate
Received by:
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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
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: April 7, 2017
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4474C for a Cesspool/Septic Tank Construction
Permit submitted by:
F & S, LLC
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
ELI7ABETI1 A. NEVILLE �'Z` 0�� Town Hall, 53095 Main Roa,
TOWN CLERK ca _ P.O. Box 11.79
Southold, New York 11971
REGISTRAR OP VITAL STATISTICS `y
MARRIAGE OFFICER �` Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ��� �� Telephone (631) 765-1800
FREEDOM OF INFORAIAT!ON OFFICER � �` sou tholdtown.northfork.net
OFFICE OF TI3E TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 or Non-Residential @$25 X Application o. 'I Ll 71-/Permit No. / —0C
C
Applicant Name , LL C
Ap licant.Mailing Address
Septic Tank. or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: , z -�-
Owner Mailing Address: 53. 9 Eld(A)G-),
I
Owner Property Address:
,4r,5
Name and phone number of contact perso ��
Tax Map No: Section U Block Lot
Cross Street
NOTE: LOCATIO MUST-" SUBAUTTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRE'S SUR {ALTH DE AIZT' +NT APPROVAL
//;7
g ature of Applicant ate
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