HomeMy WebLinkAboutBerninger, Mary Lour„ .A
ELMABLYM A. NESE
TOWN CLXRK
RBGIS' &&-R OF VITAL STA.TWnCS
MAMAGE OMCER
RECORDS WANAGWIEN'T OFFICER.
FREEDOM OF nUORMATLON OFFICER
Town. Haid, 53095 Main Road
P.O. Bog 1179
Southold, Newyork 11971
Fag (631) 765-6145
Telephone (631) 765-1840
sautholdtown.northf .net
OFMCE OF TOWN CLERK
TOWN OF SOi3THOLD
0 SlDU.W0I.D WA WATER DISTRICT
Al
CONSTRUCTION or ALTERATION PERMIT
cEwwL. or SEP'T'IC TANK
- t
r Non Residentiial @ $u Application No. ? 3 o I
$10 o
ResldentLal. @ Femirt N%.
ApplicsmtName FgCOI�IC CESSPOOL
Applicant Mailing Address
LAS,, IOW YORK 11948
Septic Tam:; Or'1—=---
Brief Desc: p sed Construeft or Alteration
• s• a• •t • w •r 1 :R+sVA
•a1
Name and phone aumbm of contact per=
Tot l%
Tax Map No: Section Block
Cross Street av I ua11
NOTE: LOCATION• MAP MUST
CONSTRUCTION REQUIRES
llipa f Appiicant
Received by:
Date
AL
�S�gsb� Rd
Ile
F f 1,
***RECEIPT***
Date: 04/22/15 Receipt#: 183314
Quantity
1
Notes:
Payment Type
CASH
Transactions
Septic Permit - Construct - Resid.
Amount
$10.00
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: Peconic, Cesspool
P O Box 487
Laurel, NY 11948
Paid By
Peconic, Cesspool
Reference Subtotal
4309 $10.00
Total Paid: $10.00
Clerk ID: SABRINA Internal ID: 4309