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Home My WebLink AboutKnatz ELIZABETH A.NEVILLE,MMC ,may. y Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 cm CA Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ® Fax(631)765-6145 MARRIAGE OFFICER �'� ®� Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER ®.d 3 www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD ® 1E9[E0V[E n TO: Southold Town Building Department U U L - 6 2017 FROM: Sabrina Born, Southold Town Clerk's Office BUILDING DE,Q. DATED: July 5, 2017 TOWN OF SOI OLD RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 4494 for a Cesspool/Septic Tank Construction Permit submitted by: Derek Knatz 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 t Signature Dated f ELIZABETH A. NEVILLE,MMC Town Hall,53095 Main Road TOWN CLERK m 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: July 5, 2017 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 4494 for a Cesspool/Septic Tank Construction Permit submitted by: Derek Knatz 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 ELIZABETH A. NEVILLE Town Hall, 53095 Main Road TOWN CLERK p 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 @ $101 or Non-Residential @ $25 Application No. f Permit No. Applicant Name Oea q'�7— Applicant Mailing Address h GH Ewe r[cjyt r s Septic Tank or Cesspool Brief Description of Proposed Constru tion or Alteration��l�' f Sp�0� i� a ' icW ie Location of Proposed Construction/Alteration: Owner of Property: &T A119 Owner Mailing Address: Octs 4A_ A, � Owner Property Address: { C�C l Ci I et 5- Name and phone number of contact person � I_) � Tax Map No: /600 Section V /07 Block Lot � �- Cross Street (' G CCS,2 NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY—WITH HEALTH EPARTMENT APPROVAL ,. i ature of Applicant Date @ s ,. Received by: �2�J O�NP 0,2 nn�® i o� _ J 0. of \ a 'K�> w� \ \ \ `\ zp O ti�ot�l �o> y o. '\0 �`�� o KAGE - O \� LD_ oo S' QP COQ ry\. F.F. iL�9.5' w 0. Lu `,i��\ o Lu