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HomeMy WebLinkAboutDworkowitz, Alan I°°#111 OFFi Lo � JUDITH T.TERRY ���1_� * Town Hall, 53095 Main Road TOWN CLERK y Z P.O. Box 1179 REGISTRAR OF VITAL STATISTICS i Southold,New York 11971 � ,1 ?i �1 MARRIAGE OFFICER % �f� Fax(516) 765-1823 a�,�l� Fax (516) 765-1800 RECORDS MANAGEMENT OFFICER 1 `�► 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. 1571 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : PECONIC CESSPOOL Address 1 : P. O. BOX 972 City St Zip MATTITUCK NY 11952 Descripton of Proposed Construction or Alteration ADDITION OF CESSPOOL TO AN EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS BUILDINGS, PROPERTY LINES, AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner DWORKOWITZ, ALAN Mailing Address 1 595 WEST END AVENUE City St Zip NEW YORK NY 10024 Property Address 1 4225 PEQUASH AVENUE City St Zip CUTCHOGUE NY 11935 Tax Map No. section 137.00 block 2 lot 17.000 Cross Street MIDWOOD ROAD Building Permit Number Cross Reference: Issue Date: 11/26/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) 1.4,0 /5 7 ( „ oFF014- • JUDITH T.TERRY I' � Town Hall, 53095 Main Road TOWN CLERK y Z P.O. Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER ` ', 0�.•� y Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER _./ * *a•d" Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER ,,." OFFICE OF THE TOWN CLERK 3 !loP 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. 1637 for an ALTERATION PERMIT for a cesspool or septic system submitted by Peconic Cesspool for Allan Dvorkowitz 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. RECEIVED .00 N OV 2 51996 ignatu e Southold Town Clerk ///9.- © 96' Date OFFICE OF THE TOWN' CLERK ,,,'"""" Town of Southold 00,Of fOtk / Judith T. Terry, Town Clerk ;�Q� C�Gy�; Application No. A' Town Hall, 53095 Main Road ; Z r : Construction C_ P. O. Box 1179 z Southold, New York 11971 �' ' Alteration Telephone ,y'y� ��Ori', $10.00 - Residential !/ (516) 765-1801 1 � $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 /02-/9 APPLICANT NAME: ` APPLICANT ADDRESS: 5-04 9Z2 SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTI N OR AL ERATION: OWNER OF PROPERTY: G��� OWNER MAILING ADDRESS: .57e k,602.445-4,/t/ j4/i-e Axe. -y, /ovijz OWNER PROPERTY ADDRESS: ' �p�s � WisX TELEPHONE NUMBER OF CONTACT,7PERSON: 9-18---n 5 TAX MAP NO. : Section i3 Block// 6-- Lot / 7 ' CROSS STREET: BUILDING PERMIT NUMBER CROSS REFERENCE: Sign re of Applicant RECEIVED BY: Town Clerk's Office DATE: • • - / ‘ 11 IA/ ix-yon 5-4 by 0