HomeMy WebLinkAboutSwing Robert OFFICE OF THE TOWN ~
TOWN OF SOUTHOLD
ELIZABETH A. NEVILLE, TOWN CLERK
P.O. BOX 1179
soUTHOLD, NEW YORK 1 i971
Telephone
(516) 765-1801
Application N O.3~
Construction
Alteration
$10.00-Residential
$25.00 -Non-Residential
~UT; TOWN OF SOUTHOLD
{~/r~ OLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
fo r
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$
APPLICANT NAME:
DATE
APPLICANT ADDRESS: Iq~O~'~- ~q,q,-( IL-~ ~
SEPTIC ,~:?,i .CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ~:b~)~c
OWNER MAILING ADDRESS: ~
OWNER PROPERTY ADDRESS: L~DI
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO.: Section ¢~7 Block (~q_~ Lot ~,
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
RECEIVED BY ik~~n~e
DATE: ~/~//c2~ ~
Signature- of Applicant
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SURVEY OF PROPERTY
A T ARSHAMOMOQUE
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N Y.
1000 - 57- 02 - 27
SCALE; 1" = 30'
OCT. 20, 1999
Juoe 13, 2000 (odd~lion)
?EPT. 21, 2001 ( prop. additions )
Nov. 13, 2001 (odd/lions)
Feb. 14,2002
ELEVATIONS ARE REFER~-NCED TO N.G.V.D.
FLOOD ZONE FROM
I
99 - 306