HomeMy WebLinkAboutMehalakes Mark$OIJ~OIJ), I~I~W YORK 11911
Telephone
(631) 765-1800
~D WASTEWATER DISPOSAL DIS'/RIGq:
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Applica,ion No3 '~'l1
Construction~
Alteration_ ~___
$10.00 ~Residential V
$25.00 -Non-Residential
Permit No,
Fee ~
APPLICANT NAME:
DATE
PECONIC CESSPOOL
APPLICANT ADDRESS: P.o. Box 972
HATTITUCKf NEN YORK 11952
SEPTIC CESSPOOL ~
DESCRIPTION OF PROPOSED CONSTRUCTION OP. ALI'ERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ,ALTERATION:
OWNER MAILING AODRESS:
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER C= CONTACT PERSON:
TAX MAP NO.: Sectio~//-/~'! ~ Block (..9/~/
CROSS STREET:
BUILDING PERMIT NUVIBER CP, OSS REFERENCE:
MARK MEHALAKES
1475 PECONIC BAY BOULEVARD
LAUREL