HomeMy WebLinkAboutAlessi Kenneth ELIZABETH A. NEVILLE
TOWN CLERK
REGISTP. AR OF VITAL STATISTICS
MARRIAGE OFFIOER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Ma/n Road
P.O. Box 1179
Southold, New York 11971
. Fax(6319 765-6.~5
Telephone (631) 765-1800
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
Residential ~ $ I O__
Applicant Name
Applicant Mailing Address
Septic Tank or Cesspool__
Brief Description of Proposed Construction or Alteration
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
or Non-Residential @ $25 __ Application No. OD[ %
Permit No.
Location of Proposed Construction/Alteration:
Owner of Prope y: I'
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person
Tax Map No: Section
Cross Street
Block
,L
'NSPEOTION REQUIRED
FOR SANITARY SYSTEM
PAP, TMENT