HomeMy WebLinkAboutBayberry Builders LLC OFFICE OF 'l~t~ TOWN CLERK
'~OWN OF MOE'EI~OLD
ELIZABETH A. NEVILLE, TOWN CLERK
P.O. BOX 1 t 79
SOLrr}tOLD, NEW YORK 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
· APPLICATION
for
Application No.
Construction
Alteration
$10.00 - Residential v/
$25.00 - Non-Residential
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT ADDRESS: J~"~} Jx~-~O-'m)/~ .
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 DE PROPERTY: r~.~i~-~-,I
OWNER MAILING ADDRESS: pO .~
OWNER PROPERTY ADDRESS:
TELEP.ONE NUMBER DE CONTACT PERSON:(b °¢%
TAX MAP NO.: Section L./J B:ock 0[ Lot //' /
CROSS STREET: J/'~4 eye' '~-'~-~
BUILDING PERMIT NUMBER CROSS REFERENCE:
RECEIVED BY
~ 'jTown Clerk's Office
DATE: