HomeMy WebLinkAboutFlores RobertO1~1t'~ OF ~ TOWN Cl~
TOWI~I OF ~OU'~ OLD
~! JT.A~I~ A. NBVILLE, TOWN CL~RK
P.O. BOX 11 '/9
SOUTHOLD, NEW YORK 11971
Telephone
(63?) 765-1800
Construction
Alteration
$10.00 -Residential
$25.00 ~ Non-Residential
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
APPLICANT NAME:
DAlE
PECONIC CESSPOOL
APPLICANT ADDRESS: P.o. BOX 972
MATTITUCK, NEW YORK 11952'
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued,
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PEP, 5ON:
TAX MAP NO.: Section //~' Block /5
~ STREET: ~'~"~ ~.~'~.
BUILDING PERMIT NUMBER CROSS REFERENCE:
Lot 14
RECEIVED BY: ~ffice
DATE:
Signature of Appl~nt-
RECEIVED
MAY 15 2003
$outhold?own Clerk
F Sounders
i~Z 2*40 '~O"E. I I0 O0 '
Iot 15
~rea · 200~0 sq. ft.
THERESA
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ROBERT FLORES
670 THERESA DRIVE