HomeMy WebLinkAboutBissett James ELIZA.BETH A. NEVILLE
TOWN CLEHK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFOPaMATION OFFICER
Town Hail, 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 ~>~ or Non-Residential @ $25
Applicant Name ~ ("'"mc ~ t/~ /.(.re 7~
Application No.
Permit No.
Applicant Mailing Address ~,)- 3 /~.~ ~9'~,r. ~/~c4/'~
Septic Tank/A,, or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: ]~/r--~.~
Owner Mailing Address:
Owner Property Address: (':.v~ tO~c~'~ Putv~t ~c_~ ~/
Name and phone number of contact person
Tax Map No: Section , I I~.~
Cross Street
cNoONTSE;RULC%CI~QUI~SMSUUSRT~EI~ARAPT~MLL[CN%T~PN~O~I~
(
Young & YoUng
400 Ostrander Avenue, Riverheac~ Ne~v York 11901
631- 727-2303
Howard ~, Young, La~d S~eyor
Tho~ C. ~olpert, ~ofe~nal E~e~
Robew~ C. T~t, Awch~ect
Ro~ald E. P~ La~oape A~eh~t
COUNTY DF_,PA~.'I~EI~ Or I-I~L~ SBRVICE9
PERMIT i~)R APPROVAL OIr COI~!ffI'RUt:i-~ON FOR A
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