HomeMy WebLinkAboutWhitrock ELIZABETH A. NEVILLE,MMC �� ' ' Town Hall,53095 Main Road
TOWN CLERK �� �� P.O.Box 1179
ql Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax 631 765-6145
MARRIAGE OFFICER Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICERm
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: September 21, 2018
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4655 for a Cesspool/Septic Tank Construction
Permit submitted by:
Bruce Anderson for Kevin Whitrock.
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 approval required from the Suffolk County_Health Department
Signature
.................. ..............
Dated
ELIZABETH A. NEVILLE Town Hall, 63095 Main Roa.
TOWN CLERK P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICERS ,� 7 Fax (631) 765-6146
RECORDS MANAGEMENT OFFICER A,� P , Telephone (631)765-1800
M
FREEDOM OF INFOR .'PION OFFICER a ' x Fax
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
S O UTHO LD WASTE WATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residdntial @$ltd or Non-Residential @$25 A.ppIicat,ion No.
Pe Init No. ' nc)I.
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AppIAicant Iane._
t' tl)roP lli� c)rtress ++' m 0 0OLZO-3
Sip—tic Tudc',
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f Dei^ taozl of Proposed Cesspool "�
Brief O'n
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posed ConstTuction or [ter<ation _
Location of Proposed Coast ctio ,lteration:
Owner of Property:
Owner Mailing A.ddress-,__.^0'&'q k/
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Owner Property AAddx-e�s:
Name and phone number of contact person
Tax Map No: Section �r.�:iock Lot
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Cross Street C Q
NOTE. LOCATION MAP MUST'BE SUBM=D WITH APPLICATION. NEW
CONSTRUCTION REQUIRES S, , T 1 P SAI. 'U DEPARTME .APPROVAL
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