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Home My WebLink AboutBird, Linda REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT O~FXCER FREEDOM OF INFORMATION O~'FxCER Town Hall, 53095 Main Road P.O. B~x 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.nor th fork.net OFFICE OF ~ TOWN CT.I~.RK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEFI'IC TANK Rczidential ~ $10 / or Non-Residential @ $25 Permit No. Applicant Name Applicant Mailing .Address PECONIC CESSPOOL P. o. BOX __487 LAUREL, NEW YORK 11948 Septic Tank or Cesspool Bri¢£ D~scril~tion ~of~ Cons~ction or Alterat~on /) Location of Proposed Construction/~dtcrati?n: ~0[ / Owner Mailin§ Address: Name and phone number of contact person TaxMapNo: Section ~.~ B~c~.~ ~ Cross S~'~et NOTE: LOCATION MAP MUST BE SUBMIT~I~WITH APPI~CATION. NEW Signatt~r6f Applicant Date Reeeiv~ by: