HomeMy WebLinkAboutPeconic Sign Company ELIZABETH A. NEVILLE Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS F. ax (63~) 765-6145
- MARRIAGE OFFICER ' ..........
RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800
southoldtownmorthfork.net
~~ APPLICATION
Permit No.
Applicant Name ]"~'~'~ ~th,,vh~,~A-
Applicant Mailing Address ~ 'k~ I/~'~ ~(~'~0\~vc)~. ~) .L.~.. !']Cq~%-~c~
Septic Tank or Cesspool~)~
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: ~.~.~t'~
Owner Mailing Address: ~t-~ (~::~-'
Owner Property Address:
Name and phone number of contact person
Tax Map No: Section
Cross Street
Block
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
Signatur~ ~'f Applicant
Received by~ (9~9~~
HAP OF PROPERTY
8URVEYMD
GEORGE H. ~ MADELIhIE L.
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