HomeMy WebLinkAboutPeconic Cesspool ~.T.~AB~,-rt~ A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS i~qAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Residential ~ $10 ¢
OFFICE OF ~ TOWN CLERK
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
SOUTHOLD WASTEWATER DISTRICT
APPLIcATIoN
CONSTRUCTION or ALTERATION PERMIL
CESSPOOL or SEPTIC TANK ~
or Non-Residential ~ $25 __ Application No~ (~ ~O -.
Permit No.
Applicant Name
PECONIC CESSPOOL
Applicant MailingAddress P.O. BOX
LAUREL, NEW YORK 11948
~neP. etiC T:r:~ or Cesspool .--
Location of Proposed ConsmactiordAltemtion:
Owner of Property: -']-~ 0 g/4tg.~ ~
Owner Mailing Address:
Owner Property Address:
Name and phone number of contact person~7~f'
TaxMapNo: ,S~-tion ].~C, .Block /,
NOTE: LOCATION ~ ~ST BE S~E~TH ~PLIC~~w
CONS U ION PR°v
R~ivM by:~ ~ ~
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