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Home My WebLink AboutScavone Frank ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main 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 CESSPOOL or SEPTIC TANK Residential ~ $10 i~or Non-Residential ~ $25 __ Applicant Name ../'~tZr¢4/[r (_~,4~o/v e2 Applicant Mailing Address / [.,/)~-- g~t/~rz~ooO Septic Tank or Cesspool t Brief Description of Proposed Construction or Alteration Application No. ,-~2q2-.5"~/~ Permit No. Owner of Property: Owner Mailing Address: Location of Proposed Construction/Alteration: Owner Prope~ Address: Name and phone number of contact person Tax Map No: Section / ~ ~ Block Cross Street ~e~ ,~-~ NOTE: LOCATION I~IAI~MUST BE SUBMI~TEI~WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURimi DE~_~AI~_~NT APPROVAL ~ignature o~f~licant ' Date Received by: ?1~ ~ .oi