HomeMy WebLinkAboutLuyster, Charles ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hail, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10/or Non-Residential ~ $25 __
Application No. __
Permit No.
Applicant Name ~0 {~/~' ~ Cf
Applic= ling Addre.
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
Received by:
Location of Proposed Constructio~A~l~n:
Owner of Property: ~-~-- ~ L/~.)dfl~&aC
Owner Mailing Address:
Owner Prope y Address: A:*
Nme ~d phone nmber of contact person
T~ Map No: Section f~ Block 2 ~t ~
CrossS~eet ~ ¢~5 .Pr,'F e
CONSTRU~ION ~QUI~S S~Y WITH ~TH DEP~T~ ~PROV~
~. ~~e of Appfic~t
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ]FOUNDATION 1ST
[ ]FOUNDATION 2ND
[ ]FRAMING / STRAPPING
[ ]FIREPLACE & CHIMNEY
[ ]FIRE RESISTANT CONSTRUCTION
[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
REMARKS:
INSPECTOR~--~ ~