HomeMy WebLinkAboutWysocki, Edward
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
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Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 1197I
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown ,northfork. net
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FICE OF THE TOWN CLERK
TOWN OF SOUTH OLD
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TO:----IQ'.' 'SotiHidi'd'tB
ilding Department
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 3615 for a Cesspool/Septic Tank Construction or
Alteration Permit submitted by:
Edward Wysocki
Please review the application and location map and advise ifthe project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me.
Linda J. Cooper
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I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
~
DISAPPROVE
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Signature
P7/;/ /1;(,
Dated F /
ELIZABETH A. NEVILLE ... ~
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53096 Main Road
., P.O. Box 1179 .
Southold, New York 11971
Fax (631) 766-6145
Telephone (631) 765-1800
Boutholdtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTH OLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10_ or Non-Residential @$25_
Application No. (j:) I ~
Permit No.
Appli~lN=, hH~~ t ~'
ApPli:c;t;~7J;~i~? -- ~"
Septic Tank____or Cesspoo ~ /
Brief Description of Proposed Construction or Alteration Aizr P/ "t..L,. uS e-
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Location of Proposed Construction! Alteration:
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Owner of Property. C'~~eg.J'1f/7 5rx>4 J
Owner Mailing Address: :i?"1c;.::> J .4.FJ /"/ ;z. I) ,
d7Pf~ r I' ICy /1~J7
Owner Property Address: 0j~ ~
Name and phone nwnber of contact person
Tax Map No: Sectionp- / -Y.(JfJock
Cross Street
Lot
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY TH D TMENT APPROVAL
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Received by:
SURVEY OF PROPER
SIlVA lEi ORIENT
TOWN. SOUTHOLD
SUFFOLK COtJNTY, NY
LK COUNTY DEPARTMENT OF HEALTH SERVICES
SURVEYED 01-21-"1"1
PROPOSED 12-02-03'
SET c.oRNER5 01-20-04
REVISED 02-21-05
SUFFOLK GOUNTY TAX #
1000-20-1-3.8
N
W+E
S
USKIU'IIW TO:
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PROPERTY LIES IN ZONE DISTRICT R-OO
AREA = 00.044 SF OR 1.831 ACRES
6RAPHIC SCALE
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1"= 40'
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JOHN C. EHLERS LAND SURVEYOR
6 EAST MAIN STREET N, Y.S. LIe. NO. 50202
RIVERHEAD. N.Y. 11901
369 8288 Fax 369-8287 REF.\\Hp server\t\pros\99-102K.pro