HomeMy WebLinkAboutMaher Eugene ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
· ~, MARRIAGE OFFICER.- ·
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hail, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631)765~1~5
Telephone (631) 765-1800
sou~ho]dtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
/
Residential ~ $10 Jot Non-Residential ~ $25 __
Application No. ~0 [
Permit No.
Applicant Name~/~
Applicant Mailing Address
Septic Tank or Cesspool
Location of Proposed Construction/Alteration:
Owner of Property: ~-~
Owner Mailing Address: 4'~
Owner Property Address: ~L- ~[~ ~,~)~ }.~
N~e ~d phone number of contact person
Tax MapNo:~ Section 5~ Block
Cross Street ~g~ ~
NOTE: LOCATION ~P MUST BE~IY~TH~~N. NEW
CONSTaUCTION ~QUI~S SUaVEN~ITH ~.E~ D~~APP~OV~
Received by:
Lo~ ~7
subdivision - 2"
EstoteS, SectiOn
,'Summit (,vocOn*-)
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