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Get NY WWM-104 - Suffolk County 2012-2024

Partment Ref. No. APPLICATION TO UPDATE AN EXISTING PERMIT TO CONSTRUCT SEWAGE DISPOSAL AND WATER SUPPLY FACILITIES FOR A SINGLE FAMILY DWELLING REFER TO REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS PLEASE COMPLETE APPLICABLE SECTIONS OF THIS FORM. ALL SIGNATURES MUST BE ORIGINAL. SECTION 1 FOR ALL RENEWALS AND TRANSFERS EXISTING REFERENCE NUMBER: District Tax Map No.: Section Block Name of Current Applicant: Lot Tel#: ( ) - Tel#: ( ) - Mailing Address: Email Address: Name of Curre.

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