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~'~ ~
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· ~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¥
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LOT 22
DWE;LLING W~TH puBLIC WATER
)5£D
~8/ 44'