HomeMy WebLinkAboutTupper, Shelley SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3612 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
-ABANDON ANTIQUATED CESSPOOL, INSTALL A CLUSTER OF 4-21X 8' PRECAST
RINGS IN DRIVEWAY 75' FROM WATER
-MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS,BUILDINGS,PROPERTY
LINES AND WATER BODIES.EXCAVATION INSPECTION REQUIRED
Name Of Owner A. SHELLEY TUPPER
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Mailing Address 1 3050 MINNEHAHA BLVD
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City St Zip SOUTHOLD NY 11971
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Property Address 1 SAME AS ABOVE
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City St Zip 0000
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Tax Map No. section 83.00 block 3 lot 4-'0U- lt`
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Cross Street HIAWATHAS PATH
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Building Permit Number Cross Reference:
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Issue Date: 1/09/08 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
ELIZABETH A.NEVILLE �O��,of SOUTy®� Town Hall, 53095 Main Road
TOWN CLERK O 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) 765-1$00
FREEDOM OF INFORMATION OFFICER �lif'C®U ,� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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TO: Southold Town Building Department0i DEC 9
t
FROM: Michelle Martocchia, Southold Town Clerk's Office --• "
DATED: December 19, 2007
Transmitted herewith is a copy of application No. 3771 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Stanley F. Skrezec for A. Shelley Tupper
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
Dated
P
OF'PICE OF THE TOWN CLERK �fOL
Town of Southold �OCj� K�'OGy Application NO2=1
Judith T. Terry, Town Clerk
Town Hall, •53095 Main Road Construction ;
P. 0. Box 1179 v rn Alteration
Southold, New York 11971 q
Telephone �,� • .a0� $10.00 - Residential
(516) 765-1801 $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. ®<,
Fee $ 10 .0'V
DATE be,(-
APPLICANT
APPLICANT NAME: °
APPLICANT ADDRESS: ,a,; L'ta !
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION;
tAk
01A M 'R,I
LOCATION- MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: 0, ' � ��i� ;.� ��i�, LA,a, �AL y
OWNER PROPERTY ADDRESS: t�} 6 � ;
TELEPHONE NUMBER OF CONTACT PERSON: U,, `�" .
TAX MAP NO. : Section Block Lot
CROSS STREET: J±Z A " �� ,`
BUILDING PERMIT NUMBER CROSS REFERENCE:
Sigr,Aature of Applicant
RECEIVED BY:
T wn C1 erc s Office
DATE: ` f
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