HomeMy WebLinkAboutSpiro, Argyrides T~WN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RE~ORD8 MANAGEMENT OFFICER
Town Hall, 55096 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
FREED,0M 0F I~..~fION OFFICER southoldtown.northfork.net
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~(~~ APPLICATION
^,~~ CONSTRUCTION or ALTERATION PERMIT
~°~r~ CESSPOOL or SEPTIC TANK
Residential ~ $10 Vor Non-Residential @ *25 __ Application No. 3<~r~
Permit No.
Applicant Name
PECONIC CESSPOOL
Applicant MailingAddress P.o. BOX _.787
LAUREL, NEW YORK 11948
Septic T~tnk or Cesspool
Bric,Description of Proposed Co~tr~[i,on or Alteration r~ .
'.~-_ ' '/7 J- "
Local/on of Proposcd Constm,~ition/Altem~i/)n: __ r~
Owner Property ^ddress:
Name and phone number of contact person · ~jN~4/ ~--/~'
Tax Map No: Section ~ [ Block ~,~ Lot O(
Cross S/feet
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT AI~RO~AL
Received by: ,,__~