HomeMy WebLinkAboutConsiglio ELIZABETH A. NEVILLE, MMC '����� '�� 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 �u �� �! 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: Southold Town Clerk's Office
DATED: December 4, 2018
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4682 for a Cesspool/Septic Tank Construction
Permit submitted by:
John & Clare Consiglio
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
w �o
ELIZABETH A. NEVILLE
TOWN CLERK d ��� +a" 7,�
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RECEIVED
OFFICE OF THE TOWN CLERK [-uRECEVECD
TOWN OF SOU`1'HOLD
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SOUTI-TOLD WASTEWATER DISTRICT
APPLICATION Southold Townclerk
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential (a', $10 M:;O Non-Residentiala� S-15 Application No.yo - IV - 0107
Permit No. L (A%12 -
Applicant Name
J®�h t C
/of Cons. a',o
Applicant Mailing Address oil (S rAAt ST, So,
10A r& i`� " loll '/
Septic Tank Zor Cesspool
Brief Description of Proposed Construction or Alterationh
y►t.�,.!_ Stn �c- FA..., l� rG s�_�entt _
Location of Proposed Construction/Alteration
Owner of Property J -r C1APC-
Owner Mailing Address 1.._ G/n n'r Sr S®
S looti-sbvr IV.y ®97y
Owner Property Address 6-11 _bl drroA=s 44vte
�out�® (j
Name and phonc number of contact person J04"\ 0$ 6 � 0
fax 'Llv1ap No. 1®� U Section Sy Block _ ®.3 Lot /5` ._
nAve -
NOTE:
.
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURA, 111 IEALTH DEPARTMENT APPROV AL
w.
or� turc of Applicant I a� �
Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 12/04/18 Receipt#: 249993
Quantity Transactions Reference Subtotal
1 Septic Permit- Construct- Resid, 4682 $10.00
Total Paid: $10.00
Notes:
Payment Type Amount Paid By
CK#491 $10.00 Consiglio, John
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: Consiglio, John
97 Grant St S.
Sloatsburg, NY 10974
Clerk ID: JENNIFER Internal ID:4682
F--ik-EE.-CEIVEID
Dm -�, 4 2018
Southold Town Clerk
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