HomeMy WebLinkAboutSchembri HomesTOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No,
Pee $ ~ /
SEPTIC CESSPOOL
OESCR[PTIOH ~O CONSTRUCTIOH
LOCATION MAP: Must be attached hereto before permit may be Issued.
LOCATION OF PROPOSED CONSTRUCTION OR ~LTER, ATION[ I
OWNER OF PROPERTY~ _~-~('7~Y~" I ~"~/~('~,~
~~~ t~ . I I ~1
OWNEE PROPERTY ADDR~SS:~~~' ' ~~ D
TELEPHONE NUMBE" OF CONTACT PERSON: ~W ¢/a W ~V
. CROSS REF ENCE:
Signatur~of Applicant
Town Clerk's Office
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