HomeMy WebLinkAboutDelfino VeronicaOFFI(~ OF T~]~ TOWN C~
~K)WN OF SOUI~[OI,I)
~ .rz ~BETH A. NEVILL~ TOWN CLERK
P.O. BOX il~)
SOLrI'HOLD. ~ yORK 11~71
TelePhone
(63t) 765-1800
Application No.
Construction
Alteration
$10,00 -Residential .~.
$25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR A~.,TERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF ~TRUCTIO.N E
PROPOSED CON.' ~;;{-~AL'I; I~_TION:'
OWNER oP ,' -'
PROPERTY -'
OWNER MAILING ADDR~
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO.: "' ion ~'J'~ Block OI Lot I ~
CROSS STR EET :~ 4a~'l'~LJl~ , ,
BUILDING PERMIT NUMBER~CROSS REFERENCE: ...,/"'~...
03NIWNIYPI N/fl01 - IN3PI3AYd 1~¥Hd$~ ,g~
20 6'50"E 50.00'
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