HomeMy WebLinkAboutMcgreevy John ELIZABETH A. NEVILLE
TOWN CLERK
REGISTIL~R OF VITAL STATISTICS
MARRIAGE OFFICER. · .. ·
RECORDS M-~qAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax ~631) 765-6~[~: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/ or
Applicant Name
Applicant Mailing Address
Septic Tank "~6r Cesspool
Brief Description of Proposed Consmmtion or Alteration
Non-Residential ~ $25 __
Permit No.
Application No. ~'~[ 2°
Location of Proposed Construction/Alteration:
Owner of Property: ~lj:~o~ --f~c,,, ~ ~-~-~
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person
Tax Map No: Section /o 6, Block ~ Lot .~
Cross Street J/? / .,~ ~'
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Received by: C~
Date
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