HomeMy WebLinkAboutMantione m
ELIZABETH A. NEVILLE, MMC �� � '` Town Hall,53095 Main Road
TOWN CLERK1'`i P.O.Box 1179
11
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631)765-6145
k hu4 _
MARRIAGE OFFICER � �� ��
,� Telephone(631)765 1800
RECORDS MANAGEMENT OFFICER �u 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: July 31, 2018
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4634 for a Cesspool/Septic Tank
Construction Permit submitted by:
Peconic Cesspool for John Mantione
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
r
Dated
�� ,
ELIZABETa A. NEVILLE � „ r Town Hall 63096 Main R,oa^
TOWN CLERK :� P.O. Box 1179
RD, OF VITAL STATISTICS
Southold New York 11971
MARRIAGE OFFICER' Fax (631) 765-6746
RECORDS AGEMENT OFFICER " ( Fax
(631) 766-1800
FREEDOM OF INFORMATION OFFICER J' 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.
�... ,- .,. �Grl�i.i:No.
Applicant Name t/ �
Applicant MailingAddress
y
Septic or Cesspool--
Brief Descri tion o Pro ed: '? -.fictioor Alteration
d
� d n
Location of Proposed Collstmotl AI e atron: -
Owner of Property:
Owner Mailing Address;_ t
Owner Property Address:
T1 3
Name andhone number of contact ct person
Tax Ma No: Section
Map wm. Block Lot
Cross Street
NOTE: LOCATION MAP MUST'BE SUBMITTED....1WITII APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WTFH IPE ` II DEPT "M r- .PPR, ".)V J
. S�gnat�Ile o1"�.°, .lal�'�i .ItDr�t�
Received by:
1
f
J
ELIZABETH A. NEVILLE, MMCTown Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS pRh 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: July 31, 2018
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4633 for a Cesspool/Septic Tank
Construction Permit submitted by:
Jeff Hallock for Dianc & Ed Dale
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
ELIZABETH A. NEVILLC F, �� '. Town Hall, 63096 Main R,oa.
TOWN CLERIC P.O. Box 1179
REGISTRAROF VI'T'AL STATISTICS �
Southold, New York 11971
MARRIAGE OFFICER ) Fax (631) 766-6146
RECORDS MANAGEMENT OFFICER x�' �" Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFfCER 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 ApplicationNo.
"
Permit No.
.. ....
Applicant Name 0
Applicant Mailing Address —30 )A '
Septic Tail e oI- Cesspool
BriefDcscdption ofProposcd Construction or Alteration _
Location of Proposed Cons truction/Alteration:
Owner of Property: " _,
7
Owner Mailing Address:
Owner Property Address: ,'-
Name and phone number of contact person
Tax Map No. (��� Section Block� � �.�� � m
' � '�:::
Cross Street
NOTE: LOCATION " MUST'BE SUBA4177FED WITH APPLICATION. NEW
CONSTRUCTION RE'QUIRES SURVVVY I 'H IIEA„I "I I DI�11A' RTAWWT' APPROVAL
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