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Home My WebLink AboutCimio Q�Og�FFOL/►coG ELIZABETH A.NEVILLE,MMC may. y Town Hall,53095 Main Road TOWN CLERK %� P.O.Box 1179 H Southold,New York 11971 REGISTRAR OF VITAL STATISTICS • Fax(631)765-6145 MARRIAGE OFFICER y� �Q� Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER ®.� „�► www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD D [EC[Eo��[E @/ DD TO: Southold Town Building Department JUN - 6 2017 FROM: Sabrina Born, Southold Town Clerk's Office BUILDLNO DEP,. DATED: June 6, 2017 TOWN OF SOUTTHOLD Transmitted herewith is a copy of application No. 4491 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Peconic Cesspool for Cimio 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. RECEIVED � G` Signature JUL 1 1 2017 D e Southold Town Clerk c ELIZABET14 A. NEVILLE,MMC ®' Town Hall,53095 Main Road TOWN CLERK m P.O. Boy: 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: June 6, 2017 Transmitted herewith is a copy of application No. 4491 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Peconic Cesspool for Cimio 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 1S7WA-L.A' ray edrr vmv mmwo.4®.a+e� P.O.Box 1179 S=thoNew York 19 711 ..:. (631)765I45 MA=AGE 0MCER T410Ph=e(633)76=.-Ism o�an ntoz rASM=op U.70MATION OPMER TGVN CLERK TOWN O �THOLD D LMMATION PERAW C TANK -p.E03NIQ =SSPOOL Applicant Septic,T :'sOr or Bfief on oumposedOmstu, of d phone n=bw of oonllact Block_ Crm svea AP FL a NEW NOTE: LOCATION W BE Date E.!..1. ___�_.. �, �``�.. �J ,� �� /`, .��"�j l�-�� _J °�� @� ��, r1 �� * * RECEIPT * * ®ate: 06/06/17 Receipt#: 221516 Quantity Transactions Reference Subtotal 1 Septic Permit - Construct- Resid. 4491 $10.00 Total Paid: $10.00 Notes: Payment Type Amount Paid By CASH $10.00 Peconic, Cesspool Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Peconic, Cesspool P O Box 487 Laurel, NY 11948 Clerk I : SABRINA Internal In:4491