HomeMy WebLinkAboutPalumbo Anthony 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
...... 1800
Telephone (631) 765-
southold~own.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 Mailing Address ?,,0, ~ ~,~ ~ 0 ~
/c/tv _cv/A;/k ,
Septic Tank or Cesspool t, N3
Brief Description o£Proposed Construction or Alteration
Application No~O~ '~
Permit No.
Location of Proposed Construction/Alteration:
Owner oferoperty: A-"'~,o~-)~ /~/. /~t~&
Owner Mailing Address: p~<~. ~-~ ~
Owner Property Address: 2 ~ _ G ~
N~e ~d phone nmber of contact person ~%
Tax Map No: Section ffffO Block --~ ~t
Cross Street ~-~ ~ [~
NOTE: LOCATION ~P MUST BE SU~ ~TH ~PLICATION. NEW
CONSTRUCTION ~QU~S SURLY ~TH~EA~TH DE~MENT APPROV~
Si~a~rc of Applic~t Dart
Received by:
E