HomeMy WebLinkAboutFeigelson LindaOFFICE OF T,HE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk
Tow~n Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971
Telephone
Application No.~½ ~'~'
Construction
Alteration ~-.
$10.00 - Residential
(516) 765-1801,, ~,~) ~'~. '~ $25.00-Non-Residential
· ~ S(] D WASTEWATER DISPOSAL
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
APPLICANT NAME:
APPLICANT ADDRESS:
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSEI~ CONSTRUCTION OR,A~LTERATIOkl
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:,.
OWNER PROPERTY ADDRESS: ._) t""~-~
TELEPHONE NUMBER OF CONTACT PERSON:____~7~
TAX MAP NO.: Section. /'~ Block ~ Lot
BUILDING PERMIT NUMBER CROSS REFERENCE:
RECEIVED BY:
DATE:
~-~/ ' u~i~nature of A~l~licant
76S.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST
[ ] ROUGH PLBG.
[ ] FOUNDATION 2ND
[ ] INSULATION
[ ] FRAMING
[ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: ~
DATE