HomeMy WebLinkAboutJohnnidis, Nocolas REG~ OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEI~iENT
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldWwn.nor thfork.net
OFFICE OF T~.~ TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10i or Non-Residential ~ $25
Application No. ~
Permit No.
Applicant Name PECONIC CESSPOOL
ApplicantMailing.Address P.O. BOX .._487
LAURBL, NEW YORK 11948
S~tic T~r:~ or Cesspool ~/~/>[~
Brief D~scLptio--~ of Proposed Com'i$ction o¥~lterafi, on
Location of Proposed Consl%-u/Xion/~dteration: /,~ ~f ('
Owner Mailing Address:
Owner Property Address: -. p/~,Ct~ C~(/t C~ NY
Name and phone number of contact person ~ ,~'~c~ -~
Tax Map No: Section C~. Q, _ Block I Le, q, /
NOTE: LOCATION MAP MUST BE SUBMrrrED.3~Y~fH APPL/hCAT~O. g3~ NEW
CONSTRUCTION REQmRES str~v~~PR°¥aJ~
Signature of Applicant Date
Ce~oo
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING I STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIREREmST~'rc0flS'mUCTm.
REMARKS: ~
[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
[ ] FIRE SAr,', ~ INSPECTION
[ ] nm~m'llm'm~im'm~Tm~m
)o-t~'- /o
DATE