HomeMy WebLinkAboutCorcoran, Imelda "
LIMABEZt i A.NESE . i';# "/ 4 Town Hall,53�Main Both
TOWN CLERK ' g ' P O.Box 1179
p°i'' - , . Southold,New York 11971
REGbS1'f�1�R OF'DITALSTATISTICS �` Pax 031)7654145
RECOEDS MANAGIDONT OFFICER, iii . •-- � Telephone(681)765-1800
FREEDOM OF DIFORMATON OFFICER ' 4- r` ,„,i southoldtown.northfork;set
( I(6 OF 'LC ,.or al4E IQWN CLERK
• TOWN OP SOUTHOLD*
0.4 1/13crwry (4....4t ,
//' SOUTROIZ*AATEWATER DISTRICT
1 . - APPUCATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or-_ERT CC TANK •
Residential cr V$10 or Non Residential @$25 Appis on No.133 0
• Pewit No.
•
Applicant Name PECONIC CESSPOOL
Applicant Mailing Address P. O. Bog 2487.
1 NEW YORK 11945
—
Septic Tar:- or Cesspool
Brief Descliption of ' •.1*osed + , 1• chop orAiterdtion
• y' • vi• A , -1
Location of Proposed 'on/ ` ti-, -—ton:
Owner of , ' 9-a, Co r-cotz n
��� � 578
Owner Mailing Address: fO ro vx_
of e,C kf y HTES
Owner Property Add : O( o - e /le �v
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(icfs
Name and phone number of contact person '2 lot—17
Tax Map No: Section JO Ali Block ' o? • Lot_ 4,
Cross Street
NOTE: LOCATION'MAP MUST BE EMITTED WI= APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY :;' TB DEPAR ‘i ' VAI.
1111 . 1' o, .� . 7 13 15-
1 i S*alure.of Applicant Da
Received by: 0 0 . . .. .
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