HomeMy WebLinkAboutPapkin, Karen & Eric EU ABET L 4 ELLE 10.
c�G'' Town Bali,53095 Main Road
TOWN CLERK ` . ,' _ P.O.Bas 1179
°S°3 '7 ._'<r ' , Southold,i�ewYork 11971
REGISTRAR OF VITAL STATISTICS . :v im r ,
t�, Fax(631)765-6145
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RECORDS MANAGEMENT OFFICER _ ,1 Telephone(6S1)765-1800
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SOU'7i`HOLIiWA ThWATTER DISTRICT .
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CONSTRUCTION or ALTERATION PERMIT
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Residential®$10_�„ or Nola-Residential®$25 Application No. /4 33) -.
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Applicant Name P- s,, C CESSPOOL
A plicant Mailing.AddresS P• O. BOX __48T -
,LAUlm;; YORK 11948
Septic Tz- or Cesspool .
BriefDesc.:ption of Proposed Co, ction orAlter :tion 1 / /
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Location of Proposed Coz ction/Alteration:rr
Owner of Property: 'a
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Owner Mailing Address: !'1 S •e. ,
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Owner Property Address: I 5-15 6. S e .
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Name and phone number of contract person • Lir/ 51.E— 3,2
Tax 1V1.ap No: Section .1 Block 2. Lot / 0
Cross Street 0,(7._r fo')I-J-- a 8 .
NOTE: LOCATION-KA ' NIJST AE :"i! ;i4IE'I.'TED WITS APPLICATION. NEW
CONSTRUCIION REQUIRES•S€ Y*ETR HEALTH ? r ART NT ' ' ,•ell ..
,of Applicant Date
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