HomeMy WebLinkAboutFisher, William REGISTI~R OF ~TAL STATISTICS
EMARRIAGE OFFICER
CO~S ~AG~T O~R
DOM OF ~0~0~ O~ICER
Town Hall, 53095 Main Road
P.O. Box 11'/9
Southold, New York 11971
Fsx (631) 765-6145
Telephone (631) 765-1800
southold~own.nor thfork.net
Residential ~ $10
OFFICE OF TH~: TOWN CLERK
ToWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
dr Non-Residential ~ $25
pplication No._ ? G7 '
Peri.it No.
Owner Mailing Address:
APplicant Name PECONIC CESSPOOL
ApplicantMailing.Address P.O. BOX .._487
LAUREL, NEW YORK 11948
S~tic T~r£:' or Cesspool__~
Location of Proposed Construetipp/TM/t~ration: Owner of Property: /A/~ ,EE-g gZ//~
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST
[ ]FOUNDATION 2ND
[ ]FRAMING / STRAPPING
[ ]FIREPLACE & CHIMNEY
[
ROUGH PLBG.
INSULATION
FINAL
FIRE SA,-.-, 1~ INSPECTION
] FlflERESlST4NT~ [ ] FIRERESlSTANTIIENETRATION
REMARKS:
.,,~/
DATE