HomeMy WebLinkAboutHoust, JohnFF. EEDOM OF IlqFORMATION O~'~CEE
Town p~.ll; 5~095 Main Eoad
P.O. ]~x 1179
Southold, New York 11971
Fax (6~1) 765-6145
Telephone (6S1) 765-1800
southoldtown.nor thfork.net
Residcutial (~ $10
OFFICE OF ~ TOWN CLEI~K
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERM1T
CESSPOOL or SEPTIC TANK
or Non-Reddenfial @ $25
ApPlicant N~n¢
Appl/caut M/dling Address
PECONIC CESSPOOL
P. O. BOX ._487
LAUREL, NEW YORK 11945
Septic T~r~ '.'-'-~ Cesspool
BfiefDescdpfion of Proposed Construction or Alteration
Location of Proposed Cons~ruct/,o~//Altc~ation:, ,~_ /
N~e ~d phone n~b~ of ~n~ct ~n
T~ ~ No: S~on ~ Block / ~t ~
NO~: LOCA~ON'~ ~ST BE S~D ~ ~PLI~O~. ~W
CONS~U~ON ~Q~S S~~ROv~
Si~~p~t Dat~
Received b~.