HomeMy WebLinkAboutTyrer Kenneth OFFIC~ OF ~ 'I'OWN CLER~
TOWN OF SOUTHOLD
PI J 7~BI~T[t A. NEVII 1R TOWN CLERK
P.O. BOX 1179
SOUTHOLD. NEW YORK 11971
Telephone
(631) 765-1800
Application No. ~1~
Construction ~
Al teration
$10.00 -Residential ~
$25.00 - Non-Residential
TOWN OF SOUTHOLD
Permit No.
Fee $
~~-~ '~~i~SOUTHOLD WASTEWATER DISPOSAL DISTRICT
RECEIVED
AP
for '
JUN 23 2002
CONSTRUCTION or ALTERATION PERMIT $onlhold Town Clerk
SEPTIC TANK or CESSPOOL
APPLICANT NAME: PECONIC CE~SSPOOL
APPLICANT ADDRESS: P.O. BOX 972
MATTITUCK, NEW YORK 11952'
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP:
LOCATION OF PROPOSED COi'~STRUCTION OR ALTERATION:
Must be att~ched hereto before permit may be issued.
OWNER OF PROPERTY:
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDR~ SS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO.: Section .,~Z~_L~) Block
CROSS STREET=__ ~7~/I/
BUILDING PERMIT i%Ui,."FJER CROSS REFERENCE:
Lot ~/~7./ ~)~ D
RECEIVED BY:
DATE:
Signature of ~pplicant
Town ~ rk's Office
KENNETH TYRER
31 SUNSET LANE
GREENPOR~