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Application Nd503
Construction ~
Alteration
$10.00 - H.esldentlal
$25.00 - Non-Residential
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for
OLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION P_ERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee -$
DATE_~/or
- APPLICANT NAME: PECONIC CESSPOOL
APPI.ICANT ADDRESS:
P. O. BOX 972
MATTI TUCK , NEW YORK \\952-
SEPTIC_CESSPOOL V
DI;SCRIPTION OF PROPOSED CONSTRUCTiQN OR ALTERATION
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HlF~TION MAP: Must be attached hereto before permit may be Issued.
LQ~TION Of PROPOSED CONSTRUCTION OR ALTERATION:
- .OWI'!I:R OF PROPERTY: ;f-J..JIt!It.!,L YN- S'/I'!.H 21:..;1
OWNER MAILING ADDRESS: /? /} ~_ ,,:? ~S-
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OWNER PROPERTY ADDRESS: /1'80 hA.J..:t:AA.~...I ~
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TELEPHONE NUMBER OF CONTACT PERSON: c,/ .Jl.9S--'1c.,i'
TAX MAP NO.: Section II, Blod, 1 Lot I (..
CftOSS STREET: F~ '."1 ~~ .!'__
BUILDING PERMIT NUMBER CROSS REFER I ICE:
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RECEIVED BY: ,~
o own erk s Office
DATE: y
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AL & MARILYN STRAZZA
1180 GRATHWOHL ROAD
NEW SUFFOLK