HomeMy WebLinkAboutAllen Pamela OFFICg OF 1'BE 1'OWN CLIIRK
TOWN OF 8OUlllOLD
]?AI~ A. NBV!z i .'~ TOWN CLIiRK
P.O. BOX ! 179
SOUTHOLD, NEW YORK 11971
Telephone
Ai,,lica,lo,, No?
Construction
Alteration
$10.00 -Residential
(63~) 765-1800 $25.00 -Non-Residential
..J ~.~~~WN OF SO UTHOL, D
Permit No.
Fee $
CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOb~
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. 0. BOX' 972
MATTITUCK, NEW YORK 11952'
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION 'OF PROPOSED CONST.~UCTION OR ,ALTERATION: . OWNER OF PROPERTY: ~'~:~J~_..
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON~:~?'~'~-~J
TAX MAP NO.: Section ~ Block ~' Lot
CROSS STREET: ~ ~
BUILDING PERMIT NI!M~ER CROSS REFERENCE:
RECEIVED B ~ ~wn Clerk's Office
DATE: