HomeMy WebLinkAboutForrestal Jennie ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFOPdMATION OFFICER
Town Hall, 53095 MEn Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork,net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
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Residential ~ $10~'~ or
Applicant Name
CESSPOOL or SEPTIC TANK
Non-Residential ~ $25 __
Application No. 3aq7
Permit No.
Applicant Mailing Address IOtv ~- .~O,.~Df~6, ; ( ~.-
Septic Tankk/ or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: ~,,oC~ N- ',~_r3~ ~ ~( (e~
O~erM~lingAd~ess: lO~ ~ ~ ;Ce ~
Owner Prope~y Ad.ess: ~
Name and phone number of contact person
Tax Map No: Section I 00 Block
Cross Street
Lot
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
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