HomeMy WebLinkAboutNF United Methodist Church I �
ELIZABETH A.NEVILLE,MMC �JQ%1 Town Hall,53095 Main Road
TOWN CLERK ,l P.O.Box 1179
.w Southold,New York 11971
REGISTRAR OF VITAL STATISTICS r �'� Fax(631)765-6145
MARRIAGE OFFICERWF � 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: March 29, 2018
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. C4595 for a Cesspool/Septic Tank Construction
Permit submitted by:
North Fork United Methodist Church.
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: Finala�arov�rl:required from the Suffolk County Health De a tinent
Signature
Dated
ff) �
ELI �1 Town Hall, 63096 Main Road
TO CLERK R0. Box 1179
REGISTRAR OF VITAL STATISTICS . Southold,New York 11971
IAG OFFICER Fax(631) 766-6146
MARRRECORDS AGEMENT OFFICER Telephone (631) 766-1800
FREEDOM OF INFORMATION OFFICER ` southoldtown.northfork.net
�.
OFFICE
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER IST
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
°�" J
Residential @$10 or Non-Residential @$25 � Application No.
Permit o.
Applicant Naanic
Applicant Mailing Address_j 0
Brief Description of r ..� m __ ..�...
p spool
p Proposed Construction or
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address ... °""°...... ..
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Owner Property Address:, ? m
Name and phone number of contact person__
Tax Map No: Section (-3Block mQ Lot l
. . ...
Cross Street
P
NOTE:
LOCATION MAPUST BE SUBMITTEDAPPLICATION. NEW
CONSTRUCTION S UINE " F.:�" LTH D JPA.ICYM ENT APPROVAL
..........................
SibIllat= �pplicant ate
Received by:
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