HomeMy WebLinkAboutOrient Congregational Church ;; fOUre ,os,,o i
gi Town Hall, 53095 Main Road
, P.O. Box 1 179
� 1D0 Southold, New York 11971
JUDITH T.TERRY ����`;Ol * TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 75 N Residential Non-Residential X
Fee $ 25.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : STANLEY SKREZEC
Address 1 : 50 CULL POND LANE
City St Zip GREENPORT NY 11944
Descripton of Proposed Construction or Alteration
INSTALL TANK FOR NEW BUILDING AND TIE IN OVERFLOW TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner ORIENT CONGREGATIONAL CHURCH
Mailing Address 1 P. O. BOX 804
City St Zip ORIENT NY 11957
Property Address 1 MAIN ROAD
City St Zip ORIENT NY 11957
Tax Map No. section 18.00 block 2 lot 22.001
Cross Street YOUNCS ROAD
Building Permit Number Cross Reference:
Issue Date: 12/20/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
ogi oFFO(4c
75
• 0�. Off _,,
JUDITH T.TERRY •�� � �� Town Hall, 53095 Main Road
TOWNwn Hal23 P.O. Box 1179
v� z �;
^i +:' Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(516) 765-1823
MARRIAGE OFFICER y� O�
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: November 12, 1996
Transmitted herewith is a copy of application No. A 1636NR for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Stanley Skrezec for Orient Congregational Church
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 - !l
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED. h x �(�;�r�lZ 2/c
RECEIVED •
Signatu e' /
DEG 20 19986
Date
Southold Town ; , .
OFFICE OF THE TOWN CLERK ,,,,,,""`''
Town of Southold
Judith T. Terry, Town Clerk Application No./
Town Hall, 53095 Main Road ;� Constructions:
P. O. Box 1179 Alteration
Southold, New York 11971
Telephone `= 0 , ,/' $10.00 - Residential
(516) 765-1801 , $25.00 -Non-Residential ✓�
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE I ( 11- C74,
APPLICANT NAME: 4T b 3) F. c
APPLICANT ADDRESS: CO C.7 U Lt C) L n.s--
C,-ree rrT 4 u . ((
SEPTIC X CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
°MD 6-14464 w6 but CP 4. %w b4r e 6 --
FPI C s5
/90-019
LOCATION MAP. Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: O rve./4 CcM Q C'2�, 4oj L Ctur . L-„��jy4��e.S 114,40.etfl.
se
OWNER MAILING ADDRESS: p . o . �O/X [”QO_`,`M M;19,`nf p� � J
�
OWNER PROPERTY ADDRESS: ' 0ri4 krep J v30v-
TELEPHONE NUMBER OF CONTACT PERSON: Ll - - J _8 2.,�
TAX MAP NO. : Section / .5/ Block GR Lot (7%;; ,
CROSS STREET: Youxi $ Reprs .
BUILDING PERMIT NUMBER CROSS REFERENCE:
sicee?..eC
Signa ure of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
(o.R ,345)
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