HomeMy WebLinkAboutBayberry Builders OFFICE OF ~ TOWN CLERK
TOWN OF SOUTItOLD
ELIZABETH A. NEVILLE, TOWN CLERK
PO. BOX 1179
sOUTHOLD, NEW YORK 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
Application No.
Construction /
Alteration
$10.00 - Residential /
$25.00 - Non-Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No,
DATE ~' 3
APPLICANT NAME:1
APPLICANT ADDRESS: pO G~. . ~.[1
SEPTIC /C[SS~OOL ~
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LCc._
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: ~f:~6[ L~}'~ 7Ct~/
OWNER MAILING ADDRESS: ~O
,'
OWNER "ROPERTY ADDRESS~
TELEPHONE NUMBER OF CONTACT PERSON:
CROSS STRE[T: ~
BUILDING PERMIT NUMBER CROSS REFERENCE:
~//" ~ Si~na'ture of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: