HomeMy WebLinkAboutCukor, Greg & Martha
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ELIZABETH A. NEVILLE, MMC kz% Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O Fax (631) 765-6145
MARRIAGE OFFICER A O~ Tblephone (631) 765-1800
RECORDS MANAGEMENT OFFICER ~l `t•~ www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK D
TOWN OF SOUTHOLD D
TO: Southold Town Building Department OCT - 2 2013
FROM: Carol Hydell, Southold Town Clerk's Office BLDG. DEPT.
TOWN OFSOUTHOLD
DATED: October 2, 2013
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4164 for a Cesspool/Septic Tank Construction
Permit submitted by:
Samuels & Steelmand for Gre & Martha Cukor
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me. Thank you.
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Final approval required from the Suffolk County Health Department
Signature ~
Dated
f
10 ~gUFFO(,~C
ELIZABETH A. NEVILLE Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
= Southold, New York 11971
REGISTRAR OF VITAL STATISTICS y. /1f
MARRIAGE OFFICER O .tC Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 or Non-Residential @ $25 Application No.
c Permit No.
Applicant Name Si~6giLeA d12C~YYigy(J)Ir"I oCt4
Applicant Mailing Address o6 a',S ol,i 4 9OGIGl. ~t tV
Septic Tank or Cesspool
Brief Description ofProposed Construct' nor Alteration k (Ofi kLl YA n?t j L
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Location of Proposed Construction/Alteration: C
Owner of Property: t~ri 5' M a k A C Gl kc r
Owner Mailing Address: a 6-9 13 M eAd D W- Kq ~ff 1' m 0 AL 2 2 Z
Owner Property Address: -76-70 1 n d l QGI C C IC o e Coll I 'C
Name and phone number of contact person -F OW • & W ltrk 3 (040,5
Tax Map No: Section Block -7 Lot C~
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
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i Signa ure of Applicant Date
Received by: _(=j:::L
S `HOLE PROPOSED FOUR, (4
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u OWNER: 59 GREGO 3 M READOOW ROAD k
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ZONING: R•80 w
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SITE PLAN PROPOSED SEFTIG 5Y M ?
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PROJWT SITE trlcta d Robert Rushln 0) a FT. VIA. X 12 Fr. HT. (LP) INS POOL S DHS
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