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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 ',.IL, ' C~q~H±nOG ao NI,40_L AN 'Ptgr'LL I i