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Home My WebLink About23936-Z I~OItPI N~). I 'I'O~N OF S(.)UTIIOI,I) BUi 1,1)1 N(; I)1z,P^I~,THI~-NT '1'0~1 tt llAl,I. SOUTIIOI.I), N.Y. 11971 TEl.: '16~-IiJO] Di;mlq.X~ed a/c .................................. 3 SI['I'S OF t'l,^N~ ~ ............. SIJI[VE¥ ....................... CIIE(~K ........... j .......... SEPTIC,' FORH .-.~- .............. ^PI'I,ICA'rlOfl IrOP, BIIII,I)INC I'F, IIHIT l)nte ................ ,19 .... 1 N,~'l'lltl(:'l' I a. 'lhi,'; nl~lllcat, i¢~l ulml[ I}¢ (:til~)lelely filled iii by lyl~.~riter or in JJlJ~ lllxl mll~nltt~l to the I~lihlinl~ hml~ct-r w Ibis; appl i(:;ll il. illx~l nj~al o[ this al~licati(s~, the l~Hldi.[~ InBl~l:lor ~.~il I i~m~ a I~lildJng ~e~mJ~ to Ihe ~llJpJ Jcmfl:. Sx~ch i~mnJl ~mll Ix~ kept ~ lie ln'~nJ~s avai l~hle for insl~cti{~ (~:(:llj[ll[:~ ~l~lil hnve I~ll i~[mlL~l ll~ Lie I~iJldinR I~lildi.l~ 7~.e ()Idil~n(e' o[ I.he 'l~l of f~ll~)ld, ~fffolk I~,lg]lul:itsm, I'or II~ ¢(~mt[t~l:i(~ o[ I~;ihlinlF;, aMiLi{~m or aller~il:iono, or For [~waJ or d~olJtion, n~ hereJtl __ ~:g: ~.9~..~.~ ~ ~ ~:%~. ~'. 'J ....... (~lil iu8 ~lre~s o[ nl~l il:mil:) I Iq~ Slate ~hethei nl~}licanl: is ~?[, le,mqee, agent, ar(:hitect, enp~i[~eer, general comstrnctor, electrician, pll.ltx~r {ir I~Jihl F_... L ¢--- ---'P~-Io --,~-/ Cor~. ............................... ...................................... ; .... : .... · ....... ~...T .... ~.. .... -. ............... J~ln[! {It (,~l~'~r oJ! jlre~llJP, e,~ ............................................................................................. (an cxl the t[l~ toll or late.~l: dec~l) If nl~ll |emil: |.~ ~ corlx)ratic~l, ,,tig~ture of duly m~l.hor|?~l ofl'icer. (~l;ir alii lille of corlx)rate officer) I~]i tdel.q I.icense 1% .......................... r,,,,~,-~ i.i,:.e,,.~ ,,) ..... ~'~.~. ~. ....... Oiler 'l'rmb~ [,icen~ ~ ..................... I ~,,,,t~ 'n,~ ~,~, ~,. I~ ~:~ i~,, .. ........ i,,~:~ ...g.e .......... ~,,: ...'!'.J ......... (~) tlr;lie exisri~;g use a;xl ~{~;i~atK:y oF l-'e.i~e m~l intetxl{~l use taxi ,. E~i,,~ i,,~ ,,,~ ,,,.} ,~:¢~'m":Y ............... ~. ~. ~ ~.~C .... ~.0.~.~. ................................. h. Inie~M ur~ m~l ~:cul~m~:~ .............................................................................