HomeMy WebLinkAboutHanau 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: August 8, 2017
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4505 for a Cesspool/Septic Tank Construction
Permit submitted by:
Samuel W. Fitzljerald for Ken Hanau
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
S l gnature
Dated
SOFO(/re
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 or Non-Residential @ $25 Application No. 15
Permit No. R10-f 7-0011P
Applicant Name _
Applicant Mailing Address i I �L r M a 0'<
\1 S p is� u')35'0
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration w vv—q
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address: Av S-bl 01"6-Afj fit'l 06
Owner P y Address: J',7
Name and phone number of contact person -SAYA@ `' @ 0"
Tax Map No: Section Block Lota d 1
Cross Street ` .
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY TH H LT DEPARTMENT APPROVAL
Signature ;f Applicant Date
Received by:
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EXPIRES THREE YEARS FROM DATE OF APPROVAL