HomeMy WebLinkAboutGeorge Stephan OI~IC~ OF TI~ TOWN CI-~IK
TOWN OF ~OUTHOLD
ELIZABETH A. NEVILLE, TOWN CLEKK
p.O. BOX i 179
SoIfrHOLD, NEW YORK 11971
Telephone
(63rl) 765-1800
APpliC~t'on No.,..~ ~) ZJ
Construction ,..~
Alterafion /
$10.00 - Residential ~/
$25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
fo r
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ 10.00
DATE 8/04/03
APPLICANT NAME:
APPLICANT ADDRESS: P.O. BOX 2047
GRI~LrI~PORT, ~ 11944
SEPTIC X CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
~ SP~PTIC SYSTEN
LOCATION MAP:
LOCATION OF PROPOSED CONSTRUCTION OR ,ALTERATION:
OWNER OF PROPERTY: 8't'KUuA.N A~]) PATS~ GEORGE
OWNER MAILING ADDRESS: 154-52 24th AVE.
Must be attached hereto before permit may be issued.
1,1HITESTOI~E, NY 11357
11952
631 765 4900
12 Lot
OWNER PROPERTY ADDRESS: AD~I'S RO~D
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO.: Section l I~1 Block
CROSS STREET: ~'.o'z N~.~I~ Roan
BUILDING PERMIT NUMBER CROSS REFERENCE:
09
RECEIVED BY~
I I - ~'T°w'~ (~lerk's
DATE: ' l"tlo3
Office
~t~6f Applicant
Co.. ~I,C