HomeMy WebLinkAboutApostolides Bill OFFIC~ OF ~ TOWN CLERK
TOWN OF 6OUTHOLD
l~ A. NBVlI~: TOWN ~RK
P.O, ~X 1179
SO~O~, ~W YORK 11971
Telephone
(63,) 765-1800
~TOWN Of SOUTHOLD
'
SEPTIC TANK or CESSPOOL
Permit No.
Application No3
Construction
Alteration
$10,00 -Residential Y~'/
$25,00 - Non-Residential
DATE
APPLICANT NAME; PE(~ONIC CESSPOOL
APPLICANT ADDRESS: P.O. 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 CONSTRUCTION OR ALTERATION:
.OWNER OF PROPERTY:
OWNER MAILING ADDRESS: ~//~.~
ADDRESS. (~~~/;'~'-~'//g~" ' '
OWNER PROPERTY · ~ ~)~Z ~' ..~./~?//~/,~'
Lot
TELEPHONE NUMBER OF CONTACT PERSOI'.i:
TAX MAP NO.: Section /~)~ Block
CROSS STREET:
BU LD NG PERMIT NUMBER CRO%S REFERS?ICE:
RECEIVED BY:
DATE:
-Signatu~
Town Clerk's Office--