HomeMy WebLinkAboutSchembri Homes (4) OFF/CE OF TH~ TOWN CLEI~,.K
TOWN OF SOUTHOLD
]~5~ABSTH A. NSVILL~, TOWN CLERK
P.O. BOX 1 ~79
S OLqYeiOLD. ~N~W yORK 11971
Telephone
(63-:~) 765-1800
TOWN OF SOUTHOLD
Application No.~
Construction
Alteration
$10.00 -Residential
s25.00 - Non-Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee S
DATE
SEPTIC v/CESSPOOL
DESCRIPTION' OF PROPOSED'CONSTRUCTION OR ALTERATION
LOCATION MAP: Must b8 attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER PROPERTY:
OWNER MAILING ADDRESS:__
OWHER PROPERTY .ADDRESS:
Town 'Clerk's Office
TELEPHONE NUMBER OF 'CONTACT PERSON:
TAX MAP NO.: Section ~(~ Block i~) ] Lot
BUILDING PERMIT NUMBER CROSS REFERENCE:
6
Ii: