HomeMy WebLinkAboutD&T Unique Carpentry ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS ]~NAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (63~) 765-6145
'~ Telephone (631) 765-1800
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 b'/or Non-Residential ~ $25 __ Application No
Permit No.
Applicant Mailing Address ~ -7.~--- C-.J ¢) ~' ~ ~l ~f ~M' 5- K
Septic Ta~ ~ or CesspOol ' '
Brief Descdp,ion of Propo~ed Cons~n,ction or ,l~eration_ ~ ~ ~C~¢~c'~/a ~
Location of Proposed Construction/Alteration:
Owner Mailing Address: ~,~ ~ b~ ~ / 7
Owner Prope~yAddress: O~ lC C W
me,nd ho e umb* o on,a , ,r o [
rax~p~o: ~0 s,~tio~ g t ~o~k ~
Cross Street_ ~ ~ b~l~.~4. :
NOTE: LOCATION MAP MUST BE SUBMITTED WlTIt APPLICATION. NEW
CONSTRUCTION ~QUIRES SURV~TH HEALTH DEPARTMENT APPROVAL
Received by:/~/A ~ Signature of Applicant / Date
~V]~¥O~ ~,i~R, TII~ICATION
· ~E HEI~E~Y GE~.TIFY TO DONALD CONN
YOI~K DTA'YI~ A~IATION OF
) U'NTY DEPARTM~ OF HEALTH:
APPROVAL OF ~OSSTRUCTIoN
~, O~L¥,
ONALP C ONNOLL¥
LOT 42 "HI~HI~OlNT AT ~+ ~I~N, ~GTION ~"
AE ~ M~rlon, To~n oF ~u~old
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NOTES
Af~JEA = 40,451 CG. FT.
· ,~JI~I~/151ON NAP 'NI~H~OINT AT ~AST NARION, 5~GT. 2"
~ ~LY* ~, I~ ~ FILE NO. ~55.
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