HomeMy WebLinkAboutSchembri Homes (2) OFFICIg OF ~ TO~
TOWN OF ~OUTI~OLD
~IZAJ~TH A. NrEVILI-E. TOWN CLEP, X
sOUTHOLD, NEW YORK 11971
Telephone
(63-i } 765-1800
Applicatlon N o."~l ~
Construction v
Altered, ion
$10.00 - Residential --~/'
$25.00 - Non-Residential
SEPTIC TANK or CESSPOOL
Permit No.
· Fee $
DATE
· APPLICANT ADDRESS:
SEPTIC JCESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION
OR ALTERATION
LOCATION OF PROPOSED-CONST~UCTION OR :ALTER~;TION:
OWNER OF PROPE *¥:
/
OWNER PROPERTY ADDRESS:
LOCATION MAP: Must be attached hereto before permit may be issued.
'~RECEIVE D BY:
'~DATE:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO.: Section ~ Block tO / Lot
BUILDING PERMIT NUMBER CROSS REFERENCE:
Town Clerk'~ Office
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