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Home My WebLink AboutMcgunnigle Dan & Diane ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS · MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 , . Fa~ (6~1~ ~65-0145 ' Telephone (631) 765-1800 southoIdtown.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 No..~--~ Permit No. Septic Tank or Cesspool Location of Proposed Construction/Alteration: Owner of Property: ~,~ '~.t~t'q,.te Owner Mailing Address: 25 Owner Property Address: 2~f Name and phone number of contact person ~ TaxMapNo: [o*o Section o~ Block o~ Lot ¢/~ Cross Street ~ ~g ~ NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION ~QUI~S SURVEY WITH HEALTH DEPARTMENT APPROVAL Received by: ~Tfff~ Signature of Appli~ Date ~.~ O0 '60~ N 08'57'50"W ,,01, ,0£ .ZO S 225.00'