HomeMy WebLinkAboutVlahos Thomas Ol~lC~ oF ~ TOV~N
~OWN OF SOUI'~OLD
RI ,I?:ABETI~ a. NI~VILLE, TOWN CLBI~I(
P,O. BOX i179
Telephone
(63-1) 765-1800
Application No. 3.!c~..
Construction
Alteration ~
$10. 00 - Residential ~"~'
$25.00 - Non-Residential
Permit No.
Fee $
APPLICANT NAME:
APPLICANT ADDRESS: ~-~.~
SEPTIC)~ CESSPOO L'~
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION ~__~--~j:3~\~
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ,ALTERATION:
OWNER OF PROPERTY: I)~,n,"~ ~
. ..WILAPIOS
OWNER MAILING ADDRESS: '"~'-~ ~ )'~¢~c~ J
OWNER PROPERTY ADDRESS: ~'~,/~ '~)~'v~.
TAX MAP NO.: S'ctionkO~ Block ~ Lot
CROSS STREET: ~~ ~V'~
BUILDING PERMIT NUMBER CROSS REFERENCE:
RECEIVED B ~ T~w~ Clerk's Office
Sglicant'