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Monahan, Jennifer
TOWN CLERK RE(tI~TRAR OF VITAL STATISTICI~ MARRIAGE OFFIOER REOQRDS MAlqAOEMEN~ OFFICER FREEDOM OF INFOld. TION OFFICER OFFICE OF tITlE TOWN CLERK TOWN OF SOUTHOLD $OUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK .~Tewn Hall, §3096 Main Rea P.O. Box 1179 Southold, NowYOrk 11971 Fax (631) 765-6145 Telephone (631) 70§-1800 so u thold town,no~b, fork.ne~ P,-esidantial ~ $10. X. or Non-Residential ~ $25 _. Applicanl Mailing Address ?' O' ~ K Application No. Pem~it No. Owner Property Address: T=MapNo: i~ S=fion [b4 Bl°ek__O4 _ ~t il.. t~ NO~: LOCATION ~ ~ST'BE 8~D W~ ~PLICATION. ~W CON~TRU~ION ~Q~S S~Y ~H ~ DRP~T~ ~PROV~ , ~f ~plic~t Da~