HomeMy WebLinkAboutHartung, John ELIZABETH A. NEVII,LE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fsx (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__
Applicant Name
or Non-Residential ~ $25 __
PECONIC CESSPOOL
Applicant Mailing Address I Al ~ocI MV '1 'lOA~
Septic Tank or Cesspool ~t/
Brief Description o~]~ll~sed Col~lruction or Alt?ah_'on j
Location of Proposed Constru,/~t/ol~Alterat/oni / .L
OWner Mailing Address: V /~70 0d
Application No. __
Permit No.
NOTE: LOCATION MAP MUST BE SUBMrITED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY W1T~'HEALTH DI~.~NT ~APP/~ O/SAL
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