HomeMy WebLinkAboutZizzi Family LLC ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
· MARRIAGE. OFFICER'- ....
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFOILMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765.-6145
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 dot Non-Residential ~ $25 __
Applicant Name
Applicant Mailing Address
Application No. ~ {D~
Permit No.
Septic Tank_~/or Cesspool
Brief Description of Proposed Construction or Alteration ~--r.o-
Location of Proposed Construction/Alteration:
Owner of Property: 'Z., 7._'z, /~---p-/-)~,//~ /
/
Owner Mailing Address: /ff..~"). ~&.,~ / ~-/
Owner Propcffy Ad&ess: k/~; ~ 5 ~]~ ~;a~
Nme and phone number of contact person ,/~
Tax Map No: Section ~ ~ Block
Cross Street ~/~f~
Lot__//~, 1--
CONSTRUCTION REQUIRES SURVEY ~VIT~I~7
Received by: Si~e-of~
g WITH APPLICATION. NEW
,~ffDEPARTMENT APPROVAL
~licant Date