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HomeMy WebLinkAboutKarakalpakidis ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS M. ARHIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFOHMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldt own.nor thfork.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 No2~f.~/ Permit No. Name and phone number of contact person TaxMapNo: S~ti. on 031 mock tg oO I ~ot OOS'.oo..3 Cross Street ~J~'~ ~ ~g Ti~RULCO~IAffJ O~ QUI~E~U S~ ES U~I~D WIS ~URV~ Y WI[FIt HEALTH ffgA~TP LMIEC AI~TTI~ pN~oNEvA~ · ~4~nan~ o~ ~pn~ 'k Date ReceiYed by: Applicant Name Applicant Mailing Address, ~--~ --1~ C4/@'~ ~,~,L_ fl," IIiO S~tic T~ ~ or Cesspool Brief Description of~ed C~on or Alteration ~cation of Proposed Con~ctioWMteration: ~errrope~Ad~ess: q~ ~ ~m.k¥ ~' - ~ LOT 22 DWE;LLING W~TH puBLIC WATER )5£D ~8/ 44'