HomeMy WebLinkAboutBrown ELIZABETH A. NEVILLE,MMCi W`W 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 1 Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER11 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: December 28, 2017
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4553 fora Cesspool/Septic Tank Construction
Permit submitted by:
Robert I. Brown Architect for Jeff& Carol Oak
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 aairoval ie tittd froni the Stiffolk Cot111ty Llcalth Department
Signature
Dated
y a,"I
ELIZABETH A. NEVILLE `, Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS �
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICERTele hone (631) 765-1800
FREEDOM•F INFORMATION OFFICER southoldtown.northfork.net
�,„� M� ���;� "''�.
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10_X_ or Non-Residential @$25 Application No.
Permit No,
Applicant Nani,c
Applicant Mailing Addws k'D
e .� �� .. ��'-� �,��' ...�.._. .......���...........�....._... �.
w
Septic Tank for Cesspool
Brief Description of Propose Construction or Alel",',1001', ' � ���� � � � � '��
17-
Location
Location of Proposed Construction/Alteration:
Owner of Properta ""
Owner Mailing Address... . �
Owner Property AddN
Name and phone number of contacter ��
p son
Tax Map No: SectionBlock
�..�., ....... �" �....mm_.� Lot��..�.. .�. _ .....
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURYY WITH HEALTH DEPARTMENT APPROVAL
iof Applicant lam.to
Received by:
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