HomeMy WebLinkAboutCarpluk, Theodore „OF FO4c
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ELIZABETH A.NEVILLE '�`Z yam►s Town Hall, 53095 Main Road
TOWN CLERK ; p P.O. Box 1179
y = Southold, New York 11971
REGISTRAR OF VITAL STATISTICS1 '
MARRIAGE OFFICER Fax�1 Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER �O 1a)10�, Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1827 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : CRAIG M. ARM
Address 1 : 1675 JOCKEY CREEK DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-94-0084
Name Of Owner CARPLUK, THEODORE SR.
Mailing Address 1 MAIN BAYVIEW RAOD
City St Zip SOUTHOLD NY 11971
Property Address 1 JOCKEY CREEK DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 2 lot 19.000
Cross Street MAIN RD/OAKLAWN AVE.
Building Permit Number Cross Reference:
Issue Date: 3/19/98 El abeth A. Ne ille
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ',``1` Gym; Town Hall, 53095 Main Road
TOWN CLERK ; p . P.O. Box 1179
ti 2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O ��177 � Fax (516) 765-1823
MARRIAGE OFFICER �� -#310
QN.,�� Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER `_ Qljig .0 elf P
FREEDOM OF INFORMATION OFFICER _ • �5 (� (� (5
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD .. MAR i111B ..J
ai r: BLDG.DEPT. ,
TO: Southold Town Building Department _ 1-6L' ' IA
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 17, 1998
Transmitted herewith is a copy of application No. 1901 for a Cesspool/
Septic Tank Construction Permit submitted by:
Craig M. Arm for Theodore Carpuk, Sr.
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.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following reco mendations:
APPROVE
DISAPPROVE
Comments:
S'gnatur
Dated
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i ..4. Aplication No./9e/
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Cost ruction t...-------.,
A 1.71 , ' N
I'. 0. Box 1179
-. - Alteration
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m , New York 11971 .. _... ... . . . . .
Telephone * tti * 4 NNZ* if(4 • Residential.X. . . .. _._.
-:=,Jyrirfarj 516) 765- 11101 Non Residential... ... _ .. .
•I-OWN OF sOUT HOLD
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SOUTHOLD WASTEWATER DISPOSAL DisTitICT
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A199 ICAT ION
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CONSTRUCT ION or A LT ER Al ION PERMIT
SEP I IC •I'ANK (II' CESSPOOL
P(1111111 NIL......... . ...... . .
2:',.•
Fee $
...
DATE. 02::, - 17-lel
APPLICANT NAME: C140§4457 "A. Aliz-v"
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APPI.IC A N I. A 1)1)11E SS:...... .1(05 ,skget...pr. c,s24Y.- 217-vsk-c ....... ........
sEp-ric cEsspoot_._)_(__
DrscRIPTION or PROPOSED CONS'!"RUC-1 ION OR A 1...runtATION
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1..0C AT I ON MAP: Must be at(ached hereto before permit may be Issued.
• LOCATION OF PROPOSED CONST RUCT ION OR A LT ERAT ION:
OWNER OF PROPERTY :
OWNER MAILING ADDRESS:
....
.t,1)-(41-s:),. 1,1.• Ur
.... ) ...
OWNER PROPER TY ADDRESS: :3c4 ‹. Glr.2.1e-- Clec-i-•I 6-. Sz-L:r 1 rcS1-C,
TELEPHONE NUMBER OF CON T A C I PER SON
-1 AX MAI' NO. : Seclion..........70. . _Block__ (:).2.-.. ....._,....1..oljct.... . .........._.7 ...
CROSS STREET :_fyy):,,!.„..73. _Re ....._ _ _ ./...fz?,e04, .? .!_...4.......1.*2—e_,..:47:___..,:1...__._..
BUILDING PERMIT NUMBER CROSS REFERENCE : 4
S
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RECEIVED BY : '
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DATE :.........3.1./..7/4 •
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