HomeMy WebLinkAboutAdamson, Walter SUfF0�
kc0 .
JUDITH T. TERRY =�0 Gym Town Hall, 53095 Main Road
TOWN CLERK C**
"� P.O. Box 1179
Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICSO Fax (516) 765-1823
MARRIAGE OFFICER yif' • Q�� hone (516) 765-1800le
RECORDS MANAGEMENT OFFICER �� �� Telephone
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 77 N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : STANELY F. SKREZEC
Address 1 : 50 GULL POND LANE
City St Zip GREENPORT NY 11944
Descripton of Proposed Construction or Alteration
FILL IN TWO EXISTING CESSPOOLS AND ADD TWO ADDITIONAL CESSPOOLS TO THE
EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS
FROM ADJACENT WELLS, BUILIDNGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner ADAMSON, MRS. WALTER
- ----------------------------
Mailing Address 1 1770 JACOBS LANE
------------------------------
- ----------------------------
City
-----------------------------------------------------------
City St Zip SOUTHOLD NY 11971
-------------------- -- ----------
Property Address 1 WAYSIDE MARKET
------------------------------
ROUTE 25
-------- ---------------------
City St Zip SOUTHOLD NY 11971
-------------------- -- ----------
Tax Map No. section 62.00 block 1 lot 15.000
------ --- ------
Cross Street BOISSEAU AVENUE
------------------------------
Building Permit Number Cross Reference:
----------------------------------
Issue Date: 8/15/97 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
FO�,�c
O
JUDITH T.TERRY =�0 Gy
Town Hall, 53095 Main Road
TOWN CLERK o
y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O Southold,New York 11971
MARRIAGE OFFICER y� � O�� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER �,( �� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: August 14, 1997
Transmitted herewith is a copy of application No. NR 1785 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Stanley Skrezec for Mrs. Walter Adamson (Wayside Market)
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 this office.
Thank you.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - ✓�
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
t
ignatu e
Date
OF!FI�E. 0P THE TOWN CLERK
Town of Southold / 7j-c
Judith T. Terry, Town Clerk Application No. l
Town Hall, 53095 Main Road Construction
P. 0. Box 1179 z
Southold, New York 11971 tpl'i � Alteration
$10.00 - Residential
Telephone
(516) 765-1801 Ol $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE kj&wr I Lf ,
APPLICANT NAME:
APPLI CANT ADDRESS: ,
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSYD CONSTRUCTION OR ALTERATION
C-
-2 1' CES S L
v
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: L,,s
OWNER MAILING ADDRESS: ► 1� 0 ,J,aco� L,�e
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: H
I �
TAX MAP NO. : Section cz Block / Lot �J
CROSS STREET: �detS�e,.q-camp
v
BUILDING PERMIT NUMBER CROSS REFERENCE:
Si nature f dpplicant
RECEIVED BY: RECEIVED
TownAW 1 '4§ §ff
DATE: 6
Southold Town Clerk
V �
2 3A
V� {
� Q