HomeMy WebLinkAboutZoumas (3) ELIZA.BETH A. NEVII,I,E
TOWN CLEB, K
REGISTRAR OF VITAL STATISTICS
M_AP, RIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FI{EEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (651) 765-1800
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10~ or Non-Residential ~ $25 __
Application No.
Permit No.
Applicant Name
Applicant Mailing Address
ZOUUAS CONTRACTING CORP.
PO Box361
Septic Tank ~ or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property:
Owner Mailing Address:
Owner Prope~ -Address:
Name and phone number ofcontact person ~otbo ~>~- ~-¥:~?o
Tax Map No: Section ~ Block O ~ Lot ~ ~
Cross S~eet ~t ~ 6 ~ ~ ~0 ~ 0
NOTE: LOCATION ~ MUST BE~SUB~E~WITH APPLICATION. NEW
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