Pollock, Susan uarage mle Permit Application.
Return to: Town. Clerk
Town of Wappinger
20 Middlebush Rd.
_
Wappingers Falls, NY 1259()
Name: Sal S - _
(Ust) (First) (M1)
Address:
(Strut Address)
Wappingers s palls, NY 12590
(City) (ST) (Zeis)
Phone: ( ( ) _ .3.
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Address of Sale: 'CA--) k 0
(If different from above) (Street Address)
Wappingers Falls,NY 12590
(City) (S'r) (Zip)
i
Date of Sale: � � � From: t"), (C pm) until� (arxr
(Day one) (Time Begin) (Time*.End)
I From: an 5 pm) until (amllo
(�y T'wn) (Time Begin) (Time;End)
Frori: arpm) until (am/64
(Day Three) (Time Begin) (Time End)
Sign: .; Date: �.
FOR INTERNAL USE ONLY
Received by: Joseph P. Paoloni
Jessica.Fulton.
Date Received: P P
Serial M
AVE D
NO\N�l OF ' GER
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