HomeMy WebLinkAboutDemert, RobertTOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND
[ ] INSULATION
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [
REMARKS:
] FIRE RESISTANT PENETRATION
DATE ?-/~-~ ~ INSPECTOR
lq~,LIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
REC~0RDS MANAGEMENT OFFICER
FREEDOM OF INFOILMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10
Applicant Name
Applicant Mailing Address
__ or Non-Residential ~ $25 __ Application No. ~
Permit No.
Septic Tank or Cesspool
ff/Description of Proposed Construction or Alteration
/-.s /g, I( of./
Location of Proposed Construction/Alteration:
Owner of ergperty: Ro~e~ ~" b ~,~ r~ ~fa~'--
Owner Mailing Address: ~" O/~/
Owner Prope~y Ad&ess: ~-: . ~¢~ ~'~
Name ~d phone number of contact person
T~ Map No: Section / ~[ff Block
Cross S~eet ~ ~/~ ~ ~
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION ~QUI~S SURVEY WITH ~E~TH DEP~TMENT ~PR9V~
Si~ature of Applicant / D~te
Received by: