HomeMy WebLinkAboutDeegan, Francis W
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ELIZABETH A. NEVILLE
TOWN CLERK
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southold town.northfork.net
REGISTRAR OF VITAL STATISTICS
MARRlAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFO . N ~ J
If 1,,,,,' TOWN OF SOUTHOLD
J(~h~1J' SOUTHOLDWASTEWATERDISTRICT
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APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $1O~ or Non-Residential @$25_
Application No.:> "]1 Z)
Permit No.
Applicant Name re-c~ ~~
Applicant Mailing Address "f, i) I~ 'f ~ 7
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Septic Tank_or Cesspool V" (
Brief Description of Proposed Construction or Alteration 10a/~ ~ ('0 AA_jJ--r....A.
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Location of Proposed Construction! Alteration:
Owner of Property: -;'1.,- ?:-hA/CI <, W 1.4 ~
Owner Mailing Addrids: 7/ 2!: ~ 71Afi1J.. ~
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Owner Property Address:
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Name and phone number of contact person i~
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Tax Map No: Section Ie (p
Block
Lot
Cross Street / ~
NOTE: LOCATION AP MUST BE SUBMITTED WITH APPLICA ION. NEW
CONSTRUCTION REQUIRES SURVEY WITH AL TH DEP ARENT APPROVAL
Signilfure of Applicant
Received bY~~do:O , I ~!) q 10,
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FRANCIS DEEGAN
500 NORTH DRIVE
MATTI TUCK
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS:
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DATE 3-?-7'- tJ f
INSPECTOR
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