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HomeMy WebLinkAboutSage, Mike SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3608 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : STANLEY F. SKREZEC Address 1: 50 GULL POND LANE City St Zip GREENPORT NY 11944 Descripton of Proposed Construction or Alteration -ANTIQUATED GREASE TRAP.REROUTE MAIN SEWER LINE TO EXISTING CESSPOOL AND ADD NEW PRECAST CESSPOOL. -MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS,BUILDINGS,PROPERTY LINES AND WATER BODIES.EXCAVATION INSPECTION REQUIRED. Name Of Owner MIKE SAGE ------------------------------ Mailing Address 1 85 EAST GILLETTE DRIVE ------------------------------ ------------------------------ City St Zip EAST MARION NY 11939 -------------------- -- ---------- Property Address 1 SAME AS ABOVE ------------------------------ ------------------------------ City St Zip 0000 -------------------- -- ---------- Tax Map No. section 38.00 block 4 lot 810 ------ --- ------ Cross Street ROUTE 25 ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 12/13/07Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) SOF SO(/r�, ELIZABETH A.NEVILLE ��� Ol0 Town Hall,53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICER G Q Fax(631) 765-6145 RECORDS MANAGEMENT-OFFICER Telephone(631) 765-1800 M. FREEDOOF-INF6 TIb14bFFIC,ER COU southoldtown.northfork.net EC ® Z51 �' pQ� FFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Michelle Martocchia, Southold Town Clerk's Office DATED: December 10, 2007 Transmitted herewith is a copy of application No. 3767 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Stanley F. Skrezec for Mike Sate Please review the application and location map and advise if the 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. Michelle Martocchia I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: Maintain required setbacks from adjacent wells,buildings, property lines and water Bodies. EXCAVATION INSPECTION REQUIRED. Signature ;� /, a Dated "OFFICE OF THE TOWN CLERK FFO� Town of Southold �j� Ke'�l/ Application NaYq-0 Judith T. Terry, Town Clerk �� y Town Hall, 53095 Main Road Z Construction P. 0. Box 1179 c rn Alteration Southold, New York 11971 Telephone yO,j- • � $10.00 - Residential (516) 765-1801 ®1 $25.00 -Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT t SEPTIC TANK or CESSPOOL Permit No. Fee $ _ DATE C©i Wo - APPLICANT .NAME: APPLICANT ADDRESS: <�,V L L_ SEPTIC CESSPOOL DESCRIPTIONf OF PROPOSED CONSTRUCTION OR ALTERATION LQ LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: Kuk_Q SA--GC:§7 OWNER MAILING ADDRESS: OWNER PROPERTY ADDRESS: (e# e__ E�,s� ►u�C�c`,av��.� . Yc 'TELEPHONE NUMBER OF CONTACT PERSON: ��]� - I (1 D_ TAX MAP NO. : Section- Block Lotg CROSS STREET: BUILDING PERMIT NUMBER CROSS REFERENCE: Y Signature of App cant RECEIVED BY: Tow Clerfk's ll'Office v DATE:___ (c�,lr� U I©r] ` U Q-- � 3V ,