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Home My WebLink AboutMcArthur John ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Holl, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (6~1! ~6~-6145. ~Telephone (631) 765-1800 southoldtown.nor~hfork.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. 3 ~ Permit No. Applicant Name Applicant Mailing Address Septic T~ ~ or Cesspool~ Brief Description of Proposed Construction or Alteration ~cation of Proposed Constmctio~Alteration: Omer of Prope~: - O~er M~ling Address: Owner Property Address: 2z? ~or ./~ a_a/ Name ~d phone n~ber of contact person T~ Map No: Section/ooV Block /~ - ~ Lot /~. ~ Cross Street ~o~ ~d ~t~ . NOTE: LOCATION ~ MUST BE SUB~TTED WITH APPLICATION. NEW CONSTRUCTION ~QUI~S SURLY WITH HE~DEP~TMENT APPROV~ a~e of Applic~t Date Received by: