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HomeMy WebLinkAboutMahares, Thomas¥ i:P~O.~(~X{I~9; ' ,~O~IOLD, ~W ¥0~[ I 1~. Telephone (63~:) 765-1800 " for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. .. · Fee.~': · '- .: DATE APPLICANT NAME: PECONIC CESSPOOL APPLICANT ADDRESS: P.o. Box 972 ~IATTITUCK¢ NEW YORK 11952' SEPTIC CESSPOOL ~ DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERA-I-ION LOCATION MAP; Must be attached hereto berot-e permit may be issued. LO.CATION O1='PROPOSED CONSTRUCTION OR ,ALTERATION: · OWNER OE PROPERTY: -~ 0~,"~?~; ~h /~¢---~ · OWNER MAILING ADDRESS; ~35 ~~ ~ O~NER PROPERTY ADDRESS: ~ TELEPHONE NUMBER 0.~ CONTACT PERSON: TAX MAP NO.: S~ctlon ¢¢ Block CROSS STREET: BUILDING PERMIT NU'~IBER CRO55 REFERENCE: / Lot / '~ RECEIVED' ToS~P C h;3'k~.~'-p f fi ce DATE: $oufhold To~vn Clerk .5ignatu~icant ' Thomas Mahare$ 235 Sound Beach Drive ~4attituck