HomeMy WebLinkAboutSchembri Homes (5) OFFICE OF '/~E TO~5'~ ~
TOI~'N OF ~OUTHOLD
EL~ABET'z{ A. NEVn I ~: TOWN CL~IU<
P.O. ItOX t 179
SOUTHOLD, N~W YORK 11971
Telephone
(631) 765-1800
TOWN OF SOUTHOLD
Application No.
Construction
Alteraiion
$10.00 - Residehtial
$25.00 - Non-Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
APPLICANT NAME:
APPLICANT ADDRESS:
SEPTIC CESSPOOL
DESCRIPTION OI~}[~ROPOSED CONSTRUCTION OR ALTERATION
Must be attached hereto before permit may be issued.
LOCATION MAP:
LOCATION PROPOSED CONSt c
OWNER OF PROPERTY:
OWNER MAILING ADDRESS:
TAX MAP NO.: Sectio~
CROSS STREET: ~~
BUILDING PERMIT NUMBER CROSS
RECEIVED BY~~
/ Town Clerk's Office