HomeMy WebLinkAboutNicoretti, Anthony OFI~ICE OF THE TOWN CLERK
TOWN OF ~OLVrHOLD
I~LIZABETH A. NEVILLe, TOWN CLI~RK
P.O. BOX 1179
SOUTHOLD, NEW YoRK 11971
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
Application No.
Construction _
Alteration
$10.00 - Residential
$25.00 - Non-Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or 'CESSPOOL
Permit No.
SEPTIC
CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: //~'~"~'~,, .Z~h ~J~t ~
OWNER I
OWNER PROPERTY ADDRESS: J~ ~ I ~ ~
· .x u.P .o.= se~,io. ~ ~,o~ ~ Lo, I
BUILDING PERMIT NUMBER CROSS REFERENCE:
~~tu~e of Applicant
DATE:
Town Clerk's Office
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