HomeMy WebLinkAboutMalcomson, Karen
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONSTRUCTION
REMARKS:
[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
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DATE D -/~-67
INSPECTOR ~~
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Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
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ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $IO~ or Non-Residential @$25_
Application No.',l ')'l..-
Permit No.
Applicant Name
Applicant Mailing Address
PECONIC CESSPOOL
P. O. BOX 972
MATTITUCK, NEW YORK 11952
Septic Tank_or Cesspool~ 1J ___
Briefpescription of Proposed Construction or Alteration /l..o- po - - ( ~ ..u.. ) ~r-v'
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Location of Proposed Construction/Alteration:
OwnerofProperty:---.K ~ &.O-<+^"" A<..-h.
Owner Mailing Address: f.o r!>fr{- L!e.l'f-
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Owner Property Address:-1 \h?.co ~ ,All) ~..,~ ~
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Name and phone number of contact person ( G. 31) iJ.. q g -q t.Sg
Tax Map No~38'8q Section " Y. I Block II Lot ~g
Cross Street fJL J.k L~
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SU Y WITH HEALTH DEPARTMENT APPROVAL
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Received by: l/L- L--
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K!\JU~N MALCOMSON
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