HomeMy WebLinkAboutHollowel TimOFFICE OF THE TOWN-CLErK
TOWN OF SOUTHOLD
~ZAB~FH A. N~VILL~ TOWN CL~KK
P.O. BOX ~179'
SOUTHOLD, ~4~W YORK 11971
Telephone
(63-~) 765-1800
Applic~ltion No, ~ / ~ y
Construction /
Alteration
$10.00 -,Residential ~
$25.00 - NonrRes dent a
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or'ALTERATION PERMIT
SEPTIC TANK' or CESSPOOL
Permit No.
APPL,CANT ADDRESS: 'W~" ~ eT? ./<.~,~ ~.~ s,~,~
DESCRiPTiON OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be ~ssued.
LOCATION OF PROPOSED CONSTR'UCTION.OR ~ALTERATION':
OWNER OF PROPERTY: ~!~,~.~,,1_ · .~_z_4,~,.~
OWNER MAILING ADDRESS:
OWNER PRopERTY ADDRESS:
TELEP.ONE NUMBER OF CONTACT PERSON: (~--.'~ L) '7Z'~I/ '7'~7 ~ 7¢'77
TAX MAP NO.: Section '76 Block ~ Lot 1/' /
~ wn Clerk's Office
DATE: ~ ~
PLEASE
OF'CONSTRUCTION FOR A
oL~CLE ,~/L,~,.,L P.E$t'Dt2NCE ONLY
Z-24,-o~ [~s~,~o Rte
I
FOR MAXIMUM O}
OF APPROVAL
SEPTIC SYSTI:'M CROSS SECTION
I Abandonment of existing aanitary system
to be witrlessed by Health Department.
LOT: 4-1 ,~ 4,~
NAP OF: O005E~ NEC, K. .
FILED: NOV'ENIi3~R 22, Iq48 NO. 10,03
SUFFOLK
$1TUATIED: ¢;xDUTHOL_D, TO~qN OF
50UTHOLD '
DIST. I000 .SEC,,. "/.(2 E3LK..3 LOT II.I
SITE PLAN OP THE~
HOLLONELL P-.E~S I ~F:NC.,F
AF~,. 20, '02
NOV. I0, '0.2
NOV. 2,~, '02
,,.,tAN. 2DI
SlTF: PLAN
SCALE: I'' =
(~1) '/:Lrt-'7~