HomeMy WebLinkAboutBagenski, Conrad 004,,..
�guf FO(,�co .
ff'
JUDITH T.TERRY I�_ 'y� Town Hall, 53095 Main Road
TOWN CLERK •• o - • P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER `. y
RECORDS MANAGEMENT OFFICER ��O,ijig 4.0 0 Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER • ,,i°��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 3651-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner BAGENSKI, CONRAD AND KATHRYN
Mailing Address 1 4 MEADOW STAR COURT
Mailing Address 2
City St Zip WOODLANDS TX 77381-0000
Property Address 1 140 WAGON WHEEL LANE
Property Address 2
City St Zip CUTCHOGUE NY 11935-0000
Owner Telephone No. 713-367-5358
Tax Map No. section 108.00 block 3 lot 9.002
Cross Street MAIN ROAD
Issue Date: 6/26/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
'OFFICE OF THE TOWN CLERK •���F0 _
Town of Southold , Q CQG Application No. 3/ S/
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road '; $10.00 - Residential
P. O. Box 1179
$25.00 - Non-Residential
Southold, New York 11971 `
Telephone 1110 * Ot-4.1"
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE 6p - / a - R7
OWNER NAME: Conte 9-- 1�GL'f11C<�e(ls k.,
OWNER MAILING ADDRESS: LI Meadot4/ Slur Caurf
Wood Lads , TY -77 3$
OWNER PROPERTY ADDRESS: q Wa o h Whew I Lane
C tr c oe , Ny r 1435
OWNER TELEPHONE NUMBER: '113- 3v7 535?
TAX MAP NO. : Section /6 g Block 3 Lot 9 a
CROSS STREET: Ma_1 rl Kci
TYPE OF SYSTEM: Septic Tank /' _New l� Existing
Cesspool 1/ New Existing
Residential Z Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: ��
LETTER OF AUTHORIZATION
Conrad & Kathryn Bagenski
4 Meadow Star Court
The Woodlands, Texas 77381
Tel # (713) 367-5358
October 10, 1996
We hereby authorize Tom Samuels of SAMUELS & STEELMAN ARCHITECTS to act as
our agent in obtaining all permits required by SOUTHOLD TOWN, SUFFOLK COUNTY
and NEW YORK STATE for the construction of our residence on Main Road in
Cutchogue, N.Y.
,• _ s & 7 .
onrad Bagenski Date
J 0 — / g q(c,
Kathryn Ba dski Date
9
,.. i
. .-
_,-----------
7`-)
.4
1
,
A _ _ ... . •
, i -
/ Q
a ( • • • • s •
_ _ _.... ......................„ OI -k' d el .•
•
* , . • • . ••
•• • 4 ,
•••• ,
• •
P_/4t .x...
. • • . t4E,‘INI CD12 1 V e;i•\1 Oe'*.r .
• ,•
• '•
t4 0)-h) . •, • • • * , • . , • •.. .• •
v , . • ,
• ._______
- .
\ .
, , . ...‘ . ,•
., .,.. - , •
. ,
. , .
. :
•
. ,• . ,
. -.-• • .
•,, * , '' ' ' • • • • ...
• ..•
.i. . •
7
A' • :ft.
. ( ,
• . . „ , ,
•
". . „, ,,,,o.,,,. ,..... .•
• ..
. --... -loseM -...• •
Amig--iis
. . • ,• „le...VA.
• , , _ . ,
...s •••••DDDD.. ..
. .
.. .,
.
' ittilil ha.. „
. .
• .. *. / C12.E 17
•' ,--- / Pt^IC2 ,i.-i ; •
. • i N ., .
Pa&PDeve D
`7..._....-,... L....5-474,..........
P.Ee•iCte.t..1C.E.
--...._.
5-glieorteowts
\ lb-(Ey/ ...
, I
. ,
\
).- \ 111111 I
i 1
. .
\ , :,..*
W
\ \: L.C>CO.' 1 C)1 ,1
7 ct.
t .\
\
Z \
1 \
V \ s ef=i71 c. ..5.-1- E.—E.-•,....A
1 - 1 c,c,c oil._ ia5a•-•P71 c- -7•6.1,--.1 K.-. (157)
r.,4"‘ •• i 2- F=7" /-4r.
6.E.,a,c,-iINcz Roc L.r C L.11.)
III.. I' Ek'277 P401/4 , a' c. r-r -IT
Fu-ru;Le ffIg...Poar..1Z 1 0 N.1 lj N.1.7)E.kz.aletsi.),...iP
• \s, .1
N 1
lin\I
•
\ 0 \ I...E....A.C.4•4 I/...•1 CAI POO L. (E)() .
\ 44
i
\ 1A \`‘.
i / \
M Fm•X.IS,'...r1P.•11
\ \
00.4 E.4..1...
\ ,
,
k
\
, A
1
, ‘rl° •
•
< •
e°1/4 iSTit...1
cr; .
150 irs-r fa."014.1.5 KJ 0
LEd...a HjC4FD
Proui•40 1,"4 i-ro..4 0,4 Roo.D
• 41, 0•
ill
Ct.MEW 4°40
IProlgi No:
el N/F 1.6)4 I-4 Drawn By: u r
'Checked By: •Ts
IDate: (o e) 44.
Scale: 14 •
WA'rElt.SUPPLY AND%NAGE DISPOSAL SYSTEMS MUST
CONtOitM W1Tii NEW STANDARDS DATED NOVEMBER 13,1995. Sheet Title:
SITE
SUFFOLK COUNTY DEPARTivililiT OF HEALTH SERVICES PLAN
FEivffT ?1 C4V.tL f4 ,i,"orrilruu4,7ri4)N WOIt A
• Si i,;..4„ i.i..k.:416.14CE ONLY
Sheet No:
POP,ttAXitililM OF
EA IKE'S IIEXE YEARS FROM DATE OF APPROVAL
5 245' oco' oo"E
25,5Z
0
•
BAGENSKI R
Cutchogue, New York