HomeMy WebLinkAboutGreenfield, Murray
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [] ROUGH PLBG.
[ ] FOUNDATION 2ND [] INSULATION
[ ] FRAMING I STRAPPING D4--FINAL 4- ~
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
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INSPECTOR ~ ~
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TOWN OF SOUTH OLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [] ROUGH PLBG.
[ ] FOUNDATION 2ND [] INSULATION
[ ] FRAMING I STRAPPING p<iFINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
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DATE II .-' n ,-- 0 ~
INSPECTOR # ~
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ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
sou thold town. northfork. net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10-==: or Non-Residential @ $25__
Application No_1 ~LI ()
Permit No.
Applicant Name
Applicant Mailing Address
MATTITUCK, NEW YORK 11952
Septic Tank_or Cesspool~
Brief Description of Proposed Construction or Alteration
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PECONIC CESSPOOL
P. O. BOX 972
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Location of Proposed Construction! Alteration:
Owner Property Address:
MURRAY GREENFIELD
131 PRINCE STREET
NEW YORK, NEW YORK 10012
1 ROCHELLE PLACE
Owner of Property:
Owner Mailing Address:
MATTITUCK. NY
Name and phone number of contact person RT('HI>Rn MI>r,TT.T ?qR qr;SR
Tax Map No: Section / If if Block 4 Lot 7
Cross Street i?>M.~ /I!..d...
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
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Signature of Applicant Date
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Received by:
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:.lURRAY <';1,::,,:<1' ,"
1 ROCHELLE PLACE \~ALT LAKE LANE)
MATTITUCK, NY
144-4-7
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