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HomeMy WebLinkAboutAustin t+ba -W7 � :,ELIZABETTE TOS. 53095 Main Road A�1VILLE P.O.Bas 1179 QTOWN CLERIC ; Southold,New York 11971 1113GISITRAR OF VITAL STATISTICS (fill)765-5145 RECORDSMABRl�At�EOS {`I � VICSP. _' -"' � �, Telephone(631)765-18001 //��iRi.'S�L�}AL' }�N{/�"�Y QPPXC 1p 1 .'Q9Sa s uthoIV.Ka'ry.�3 10Dt f0 .Gt. V�lid v�1r7.1/���C'It i�VF7i�' �9;. Orr:ICE OE CLEIIIK TOWN L?B`S UTEOLD SOUTROLRWaIZWATER DISTRICT ' • • cceisTRucriati or ALTERATION +• Applca#io�No.Residential � � Or �4-FS32 . . Penult No. g •�SSPO4L Applicant Name Applicant Mailing Aess LAUREL NEW It OEK. 11948 Septic Tom' . _pr Cil Brief Desc, 'ptlot3 of ` •"sed on or • -yi4 QI1 1�.4P i cess, ,-.. • Location of Proposed Conte c A %th"7 {5 Owner Mailing Addx ss: 6 I ,o .6e1A/5.,,.//, nAi,,, , ,,/ye ,,tel iV Y /11, --c--,,, Nara and phone number of contact person Z---P47fr/(L 54Z-Y73°C Tax No: Block Lot I I , J Cross Street 1 LOCATION-NOTE: MUST BE Ste,,1 4 f syn� •f7S s fy� .� .. , • V / z7 _— %las•;srta: - Of' ' ":,mt Date rV(QANc 'e19 ft5+1- - . vv Q5 Cr) 0 fidVIC,,A) CeS5 9Jt- l ,04 40 &If \j