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Home My WebLink AboutHirsch/Banks 1 - , I l/ ELIZABETH A.NEVII,I.E,MMC ��~ c�.y Town Hall,53095 Main Road i a P.O.Box 1179 TOWN CLERKCA ze CA Southold,New York 11971 .r REGISTRAR OF VITAL STATISTICS C� � Fax(631)765-6145 631hone Tele 765-1800 MARRIAGE OFFICER 'j's� �� p ( ) RECORDS MANAGEMENT OFFICER �� 16 �` www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER CLERK D OFFICE OF THE TOWN DD TOWN OF SOUTHOLD i AUG-22-2017 -- TO: UG -22-._2017 ._TO: Southold Town Building Department B1I,D1N0 DF PT. TOWN OF SO ADD FROM: Sabrina Born, Southold Town Clerk's Office DATED: August 22, 2017 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 4511 for a Cesspool/Septic Tank Construction Permit submitted by: Frank Notaro for Hirsch/Banks 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 -0 oaf FOL Ar ELIZABETH A. NEVILL.E,MMC Town Hall,53095 Main Road TOWN CLERK P.O. Box 1179 coo 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 22, 2017 RE: Cesspool Construction Application Transmitted herewith is a copy of application No. 4511 for a Cesspool/Septic Tank Construction Permit submitted by: Frank Notaro for Hirsch/Banks 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 0 OF041 4- ELIZABETH A. NEVILLE hyo �¢r Town Hall, 53096 Main Roa, TOWN CLERK q P.O. Box 1179 Southold REGISTRAR OF VITAL STATISTICS z New York 11971 MARRIAGE OFFICER ` ` Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER ��0� a�O�r 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 Residdntial @$10 or Non-Residential @$25 Application No. . Permit No. Applicant Name Applicant.Mailing Address Septic Tank. or Cesspo 1 Brief Description of Proposed Construction or Alteration p I . , � L Location of Proposed Construction/Al ation: r Owner of Property: !� � �] Owner Mailing Address: Owner Property Address: L K5') : It Name and phone number of conta person Tax Map No: Section Block �� Lot Cross Street NOTE; LOCATION MAP MUST*BES T`I`ED WFFII APPLICATION. NEW CONSTRUCTION {QUIRE S SURVVY WITH ITEALTH DEPAATMENT APPROVAL Siture of Applicant Date Received l y: ___�_