HomeMy WebLinkAboutSchneider Ernest ELIZABETH A. NEVILLE ff~-~ TOWN CLERK
REGISTP~a-R OF VITAL STATISTICS ~
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
' ~ SOUTHOLD WASTEWATER DISTRIC
CESSPOOL or SEPTIC TANK
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldt own.nor thfork.net
Residential ~ $10
__ or Non-Residential ~ $25 __
Application No. ~ o~ 9/,~
Permit No.
Applicant Name ~.~5'-.,~_)g~'-~'-F ,/'f'-
Applicant Mailing Address for ]~5)C
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property' ~"'f~. ff~'-~7- '~--,f~ ! L ¢ t ~ N ~ ~ ~ ~ ~ ~
Owner /¢
/ , /
Name ~d phone nmber of contact person ~d~e~W ~cg~nD e--~ 7~ [-d--d 6- 3
T~ Map No: Section ~D Block ~ Lot ~
Cross S~eet O ~ o~ ~L
NOTE: LOCATION ~P MUST BE SUBMITTED ~TH APPLICATION. NEW
CONSTRUCTION ~QUI~S SURVEY WITH HEatH DEP~TMENT ~PROV~
~e of ~ic~t / Da{e
Received by: ~~
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