HomeMy WebLinkAboutKrudop Robert OFFIC~ OF 'll~ TOWN ~
TOWN OF ~OU'I~OLD
r?'~l~Erlt A. NE'V~ l l:: TOWN OJ~U(
P.O. l~OI( l 1'/~
SOUTHOLD, ~ YOP,~ i 1971
Applic_~tton No.'
Construction
Alteration
Telephone $10.00 -Residential
$25.00 -Non-Residential
(:~l:) 7:;/~ TOWN OF SOUTHOLD
/I.//~/- ,~ APPLICATION
,or '
~ 'U CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
- --~__ ~ Kl~ul:~!~
APPLICANT SS: '
SEPT I C ESSPOOL
"U
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST.~U._~ION OR ,ALTERATION:
OWNER PROPERTY ADDRESS: ~.~'0 0/~- ~",~/¢. ~
TELEPHONE NUM~3ER OF CONTACT PERSON:
TAX MAP NO.: Section, /~-'7~ Block c>t~ Lot
BUILDING PERMIT NUMBER CROSS REFERENCE: //
~~6f Applicant.
/, ~/Town Clerk's Office
Pg. 77'
OLE
JULE LANE
N 02'55'10" E