HomeMy WebLinkAboutGalati Sue OFFICg OF ~ TOWN ~
TOWN OF SOUI'HOLD
FI ;~ZABETH A, N~VILI~ TOWN CLERK
P,O. BOX 1179
SOUTHOLD, NEW yORK 11971
Telephone
Construction
Alteration
$10,00 -Residential , v
76.5~1800. $25.00 - Non-Residential
~xT~,~ TOWN OF SOUTHOL,o
LD WASTEWATER DISPOSAL DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$
SEPTIC CESSPQOL .'~
DESCRIPT~SED CONSTRUCTION OR ALTERATION
/
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO.: Section ,~o~ Block
CROSS STREET:
Lot
BUILDING PERMIT NUMBER CROSS REFERENCE:
DATE: