HomeMy WebLinkAboutManzi Homes (2) OFFICE oF'fltlg TOWN CLERK
TOWN OF ~OUTHOLD
~iZABI~TI-I A. NEVILLE, TOWN CLERK
P.O. BOX 1179
fiOUTHOLD, NEW YORK 11971
Telephone
(516) 765-1801
Application
Construction
Alteration
$10.00 -Residential
$25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
DATE I1' 20 -o3
APPLICANT NAME:'
APPLICANT ADDRESS:~' O
.~,c X c~oo.~,
=~o. o~ .~o.o~=
LOCATION MAP:
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:'
Must be attached hereto before permit may be issued.
OWNER OF PROPERTY:
OWNER MAILING ADDRESS:-~- C.~
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO.: Section lO~ ,Block
CROSS STREET: ~'t~ _~OQ ~
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