HomeMy WebLinkAboutGoldman, Sarah ~,~ o~, soLrntoLD Application No,
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SEPTIC TANK or CESSPOOL I
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P.o. BOX 972
MATTITUCK, NEW YORK 11952'
SEPT!C CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERA-F,~ON
LOCATION MAP: Must be attached t~ereto be'fore iJerlnit may be issued.
.LOC;ATION..OF PROPOSED CONSTRUCTION OR ALTERATION:
.OWNER OF PIROPERTY:~~~..~L.~.~
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER 0,': CONTACT PERSON:~t~/-~,--,---~]~_~/_
TAX MAP NO.: Section ///7 Block ~ ~ Lot /~
BUILDING PERMIT NUMBER CROSS REJ:ERENCE:
'": ' . · Signature- of A~licant
RECEIVED BY
· iL-/ ~l'own CI~'_'~jY~s ~--~fice --
S ~%}{ GOLDMAN-
480 FP~EO STREET
NEW SUFFOLK