HomeMy WebLinkAboutCarnation Properties, Inc (2) s.. 'iew.tiEFO[x0OG,
ELIZABETH A.NEVI LLE '
� i...` �f. Town Ha11,53095 Main Read
TOWN CLERK O - % P.O.Box 1179
N W • Southold,New York 11971
REGISTRAR OF VITAL STATISTICS : v.- • As ?
MARRIAGE OFFICER \ O $ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ::*Q a0.es Telephone(631)765-1800
FREEDOM OF INFORMATION OFFICER = 1 �•�I southoldtownnorthfork.net
OFFICE OF THE TOWN CLERK
\via „ , - TOWN OF SOUTHOLD
1,0
Iii.ji,•' ,1 SOUTHOLD WASTEWATER DISTRICT
ifr ) APPLICATION
0' 110 CONSTRUCTION or ALTERATION PERMIT -
CESSPOOL or SEPTIC TANK
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Residential®$10)( or Non-Residential @$25 Application No. 14 3 y 1)
Permit No.
Applicant Name f hr) &Ckelli 1A4kArr 91 4 GA I,
Applicant Mailing Address D ThX 60 R
P /Contc , n4 j (9 -g'
Septic Tank c or Cesspool
Brief Description of Proposed Construction or Alteration Loi - '11 - - 040 •r ,n
Iocra--ion -710 - 0- I k (&n4 y 171.4/h rLif_c2 ., ,y 3 ,c_�-h 4. _
Location of Proposed Construction/Alteration:
ruction/Alteration: I t
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Owner of Property: oar-bo � r7-ies 1 Tine_
Owner Mailing Address: 130 K 419 -
GArden C-iv , n U //530
Owner Property Address: (-93195 mAi n s?d
CaichcqLsoui 1193c
Name and phone number of contact person, n f-QCke(' 2/-S 1 S
Tax Map No: /O 00 Section /09 Block 0/ Lot /o
Cross Street A ftJI3% z_A
NOTE: LOCATION'MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY HEALTH DEPARTMENT APPROVAL
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