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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: