HomeMy WebLinkAboutCagnazzi ELIZABETH A.NEVELLE Town Hall, 53095 Main Road
TO CLERKP.O. Box 1179
REGISTRAR OF VITAL 6"I`A.TIS`I`ICs +gym '
Southold,New York 11971
MARRIAGE OFFICER �y� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800
southoldto .northfork.net
FREEDOM OF INFORMATION OFFICER � C
OFFICE OF THE TOWN CLERK
TOWN OF SOU T°HOLD
SOUTHOLD WASTEWATERDISTRICT
APPLICATION
CONSTRUCTION Or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential a} 10 or Non-Residential Application No, gq
Permit No.
Applicant Namem w
Applicant Mailing Address L........ �ra.�a #1 7 --
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Septic T - cr ........... ...... ..... .
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Brief Description®f Proposed Construction or Alter atioi 1 7
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Location Of proposed Construction/Alteration:
Owner of Property:_ _- ' _ P -— -........
OWIler Mailing A,ddiress:a.._.._
Owner Property Address:.........._1
. arne and.phone'nur aber of contact personvp�� Vie_,
Tai:Map 0. Section ......... Block—w A..._... Lot l
An)�, isu. l,... _ �.:...... . ............ ..
NOTE: L1ICA.11W MAP .U51" BE SURI I`I"TED WITIF. APPLICA,rl[ON. NEW
CONSTRUCTION REQUIRES SURV WITH 11EAL 1 EPAR:FI E1 T APP . A.1.1
Aare 0f Applicant Dat
Received by
..._ ...... ...
Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 06/08/20 Receipt#: 270110
Quantity Transactions Reference Subtotal
mITmm 1 Septic Permit- Construct- Resid. 4846 _ $10.00
Total Paid: $10.00
Notes:
Payment Type Amount Paid By
CK#5807 $10.00 Austin, Patterson Disston
Architects
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: Austin, Patterson Disston Architects
376 Pequot Ave
POBox 61
Southport, CT 06890
Clerk ID: BONNIED Internal ID:4846
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