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HomeMy WebLinkAboutHoffman James ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS -. ". MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFOI~IATION OFFICER Town Hall, 53095 Main Road P,O. Box 1179 Southold, New York 11971 . Fax (631) Y65-6~4.5 Telephone (631) 765-1800 southoldtown.northfork,net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $10 Applicant Name __ or Non-Residential ~ $25 __ Application No. ~ Permit No. Applicant Mailing Address x.~q ~/~.~r/XtTgl ,,,~'7L S~tic T~ ~Cesspool__ Brief D~scfiption of Proposed Construction or Altera¢on Location of Proposed Constmctio~Alteration: Owner of Prope~y: ~g 6 .. ~ Owner Mailing Address: ~ Q ~IF~ ~ ~ Owner Propeay Address: ~6~ ~a fr~.~ N~c ~d phone number of contact person q ~ ~ Tax Map No: [~ Section ] / ] Block Cross Street /~V~,. ~F~ ~g Received by: Lot , WITH APPLICATION. NEW Dat~