HomeMy WebLinkAboutPlimpton ELIZABETH A. NEVILLE,MMC � � Town Hall,53095 Main Road
TOWN CLERK " �' � P.O.Box 1179
44
Southold,New York If 971
REGISTRAR OF VITAL STATISTICS' _ �_ Fax(631)765-6145 `
MARRIAGE OFFICER ��. � Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER �,�' - `ct -www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER' �
OFFICE•OF THE TOWN CLERK
TOWN OF,SO,UTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's,Office
DATED: October 4, 2017 >' `
Transmitted herewith is a copy of application N.��: =45274 fora Cesspool/Septic Tank ALTERATION
i Permit submitted by:
Peconic-Cesspool (Elizabeth-Plimpton)
Please review the application and location map,and-advise,if the project,h'as 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 hof the project cited above and make the following
recommendations:
G APPROVE f r
DISAPPROVE
Comments: Maintain required setbacks from adjdcent-wells=•buildings, property lines and water'
Bodies EXCAVATION INSPECTION REOUIRED.,
Signature
Dated
{
ELIZABETH A.NEVILLE Town'Hall, 53095 Main Road
TOWN CLERK b P.O. Be* 1179
C,* s Southold,New"York 11971
REGISTRAR OF VITAL STATISTICS j N% Fax(631) 765-6145 MARRIAGE OFFICER � ��
I RECORDS MANAGEMENT OFFICERTeleP hone (631) 765-1800
FREEDOM OF INFORMATION OFFICER '� �'� southoldtown:northfork.net
OFFICE DY THE TOWN CLERK
- TOWN OF SOUTHOLD
i SOUTHOLD WASTEWATER-DISTRICT
APPLICATION
CONSTRUCTION.or AL', 'ERATION PERMIT
CESSPOOL.or".:SEPTIC,TANK
Residential @$10 or Non-ResdApplication No.
Permit No:
Applicant Name PECON10"C,ESSPOOL
I
' Applicant Mailing,Address
r
4
Septic Tank or Cesspool'-
'
Brief Description of ropdsedo ction'oi`Ait' 'ation
J �
Location of Proposed p �Construc Alt do
Owner of Pro e
►
f Owner Mailing Address:
Owner Property Address: l oC �
_ v�
Name and phone-number of co_ntact,perso_n
Tax Map No: Section f _"Block Lot
i Cross Street
T,7- 7 7,
NOTE: LOCATION' MAP i,MUST BE ,.SUBMITTED WI APPLI T O NEW
CONS'T'RUCTION REQUIRES SUR . Y WITH TH PAARTMET
/P'RO
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1ignatuie of_ 1 t = Date
Received by: - =
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