HomeMy WebLinkAboutDrakopoulos ELIZABETH A.NEVII'LE o.°Z� ®G'� Town Hall, 53095 Main Road
TOWN CLERgW P.O. Box 1179
REGISTRAR OF VITAL STATIS'T'ICS � � Southold,New York 11971
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER 44f� ®� Telephone{631) 765-1$00
FREEDOM OF INFORMATION OFFICER '1 11[ �' 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.
Permit No.
Applicant Name PECNIC CESSPOOL.
Applicant Mailing Address_ ' URELNY 110AA
Septic Tank or Cesspool
I3riefDescript�onof Pro s onstntc 'onQ ter ion
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:
c
Owner Property Address:
Name and phone number of contact person 74&41 /® @
Tax Map No: Section Block Lot
Cross Street
NOTE- LOCATION MAP MUST BE SUB ED WITH APPLICATION. NEW
W
CONS"T"RUCTION REQUIRESS Y WITH EALTH DEPARTMENT AP ROS
Sina Icant Date
Received by:
lr
ELIZABETH A. NEVILLE, MMC � -Olffilt Cam
Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS w 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: September 15, 2017
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4519 for a Cesspool/Septic Tank
Construction Permit submitted by:
Peconic Cesspool for Konstantine Drakopoulos
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:
Signature
Dated
S
W4e A(
(D 05'
I
n
oPds�r�d