The URL can be used to link to this page

Home My WebLink AboutDunbar Diane ELIZABETH A. NEVILLE 'TOWN CLERK REGISTB. AR OF VITAL STATISTICS · · .MAIIRIAGE OFFICER . RECORDS MANAGEMENT OFFICER FREEDOM OF INFORM_ATIOIq OFFICER TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Town Hail, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800"" southoldtown.northfork.net Residential ~ $10 ~or Non-Residential Permit No. Applicant Name /~0~./~. ~ ~ .~-~, Applicant Mailing Address Septic Tank or Cesspool /~ Bt/el Description ~ Proposed Con structi on or Alteration Location of Proposed Construction/Alteration: Owner of Property: Owner Mailing Address: Owner Property Address: Name and phone number of contact person Tax Map No: Section ~ ~ Cross Street Block / Lot // NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL * Signature of Applicant ~ Date