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Home My WebLink AboutDinizio Paul ELIZABETH A. NEVILLE ~ TOWN CLERK REGISTP. AR OF VITAL STATISTICS · · MARRIAGE OFI~ICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hail, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765r6~5 ..... Telephone (631) 765-1800 southoldtown.northfork.net SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential~ $10 ~r or Applicant Name Non-Residential ~ $25 __ · ~//t/, ~Z- t' O Application No. Permit No. Applicant Mailing Address Septic Tank "?fi'or Cesspool N/ff Brief Description of Proposed Construction or Alteration Location of Proposed Construction/Alteration: Owner of Property: ~'/-- Owner Mailing Address: ~) Owner Prope~y Address: ~,'/l~n Nme and phone number of contact person Tax Map No: Section Cross Street ~/~¢&dP ~,'/~ NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW Received by: