HomeMy WebLinkAboutCorwin ELIZABETH A. NEVILLE,MMC �� " � Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
�t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS r, " " Fax(631)765-6145
MARRIAGE OFFICERTelephone(631)765-1800
RECORDS MANAGEMENT OFFICERf www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Southold Town Clerk's Office
DATED: October 30, 2018
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4673 for a Cesspool/Septic Tank Construction
Permit submitted by:
Norma Cornu
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
�
u_.................. ......
Dated
Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 10/30/18 Receipt#: 249405
Quantity Transactions Reference Subtotal
1 Septic Permit- Construct- Resid. 4673 $10.00
Total Paid: $10.00
Notes:
Payment Type Amount Paid By
CASH $10.00 Corwin, Norma
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: Corwin, Norma
10 Sound Rd (150 Sound Ave)
Greenport, NY 11944
Clerk ID: JENNIFER Internal ID:4673
ELIZABETH A.NEVILLE 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
RECORDS MANAGEMENT OFFICER °, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER 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.
Permit No.
Applicant
al _ - _ d
_APplicant Mailing Address-10—
.
Septic Tank or Cesspoom ,
tioii of Proposed Constru
1 /
Brief Descrlp ' p ction or Alteration ''.��
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:-� ,,
Owner Property Address:_LC' m ° i
Name and phone number of contact person
Tax Map No: Section . 35 -BlockLot 20 mm
_
Cross Street �`�:..._ .....-. _......._ ..._...
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY I "III HEALTH DEPARTMENT APPROVAL
SApplicant Date
Received by: ......_ _
F
� �i
� �.
T ��, �
i
--,i
����
it
---.�