HomeMy WebLinkAboutComo Giuseppe OFI,'/CE OF TRE TOWN CLERK
~OWN OF SOUTItOLD
F~ABEfH A, NEVILLE, TOWN CL~RK
P.O. BOX 1
~OUTEOLD, NEW yORK 11971
Telephone
(516) 765-1801
Application No.~/~
Construction /
Alteration
$10.00 - Residential /
$25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATIO~N
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
DATE
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ~LTERATION.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONS~T, RUCTION OR ALT~R~ATION,:
OWNER OP PRO.ERTl: _~-/Ur~>~ ~x,x/~ ~~
. ,.
TAX MAP NO.: Section ~ Block :~ Lot
BUILDIN6 PER~IT NUMBER CROSS REFERENC~~
~ Sig n~of Applicant
1 I~JO
3(JIS_~N V ?
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S~'31A~f3S H.L'T V3H dO £N3N.L~IYd30 A.LNrlO:) ')llOdalrl$