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Home My WebLink AboutBauman Bonnie ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFOILMATION OFFICER SOUTHOLD WASTEWATER DISTRICT APPLICATION ~- CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential ~ $10 ~,~ or Non-Residential ~ $25 __ Applicant Name Applicant Mailing Address Septic Tank or Cesspool.--/ Brief Description of Proposed Construction or Alteration Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (531) 765-1800 southoldtown.northfork.net Application No.,~O Permit No. Owner of Property: Owner Mailing Address: Location of Proposed Construction/Alteration: Ow~e~ Pmpe~¥ Ad.ess: ~ cO ' Name and phone number of contact person Tax Map No: Section fO Block Cross Street NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL Signature of Applicant Date Received lJy: