HomeMy WebLinkAboutMacari Joseph ELIZABETH A. NEVILLE
TOWN CLEHK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MA/qAGEMENT OFFICER
FREEDOM OF INFOH2VIATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Seuthold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.nor thfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 ,X or Non-Residential ~ $25 __ Application No. __
Permit No.
Applicant Name ~)O ~ · '- ~
Applicant Mailing Address ./~ ~ [~.c~
Septic Tank ~' or Cesspool
Brief Description of Proposed Construction or Alteration ~ I 'TIIDIX~ ~
Location of Proposed Construction/Alteration:
OwnerofProperty: '~>~=~r~ '17.4 ~k~--'~~ ['~-~ ~'~..
Owner Mailing Address: ~ ~o ~-.~O ¥~,C~q ~ ~
Owner Property Address:
Name and phone number of contact person
TaxMapNo: Iooo Section /~ e:~.~ Block '~
Cross S~eet ,~M~
NOTE: LOCATION ~ MUST BE SUB~TTED WIT~ APPLICATION. NEW
CONSTRUCTION ~QUI~S S~~TH ~T~NT APPROV~
~~~ Si~~ ~amre of App liC~ Date
Received
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3 OF APPROVAl.,