HomeMy WebLinkAboutKar, RobertTOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING / STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] ~1~ Rwm'Mr C~TRU~ION [
[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
[ ] FIRE SAFETY INSPECTION
] FIRE RESISTANT PENETRATION
REMARKS:
INSPECTOR '~" ~? '/J~
1~.~ .T~,~BET~ A, NE%
TOWN CLEP~
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town HaU, 53095 Main Road
P.O. Box 1179
Sou~hold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldWwn.nor~h fork.net
OFFICE OF THE TOWN CLEP.~
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10
or Non-Residential ~ $25
Application No.3~'~ ~--~
Permit No.
APl~:c,~t Name
PECONIC CESSPOOL
Applicant Mailing Address
P. O. BOX.~487
LAUREL, NEW YORK 11948
Septic Tank '~ or Cesspool
BrieflDescription ~f~Proposed Constructig.r~qr Alteration
Location of Proposed Construction/Alteration:
Owner Mail/rig Address:
Owner Property Address: 3/lt~r~ T~oa,~o~ ~-~
Name and phone number of contact person
Lot ~
Section / a~" Block
Tax Map No.L.
Cross Street '~)~6. '~
~ow~: nocAno~ ~ ~ST SE S~~ ~ ~UC~nO~. ~W
CONS~U~ON ~Q~S S~Y ~TH H~TH DEP~~ ~PRO~ I
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R~eiv~ by: ~ ~