HomeMy WebLinkAboutFilipikowski, Karol OFF04eo%
JUDITH T.TERRY t'�� y�_� Town Hall, 53095 Main Road
TOWN CLERK ; y . P.O. Box 1179
v� n� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS V O � '1
MARRIAGE OFFICER p�y Os Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER N.=.Q( .. 10I Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ,�t��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1627 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : KAROL FILIPKOWSKI
Address 1 : 388 JERVIS AVENUE
City St Zip COPIAGUE NY 11726
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. SCHD REF. #R10-97-0053
Name Of Owner FILIPKOWSKI, KAROL
Mailing Address 1 388 JERVIS AVENUE
City St Zip COPIAGUE NY 11726
Property Address 1 PINEWOOD ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 110.00 block 5 lot 22.000
Cross Street DICKS POINT ROAD
Building Permit Number Cross Reference:
Issue Date: 3/20/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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Town Hall, 53095 Main Road
.j `0 _��i P.O. Box 1179
' Als �� Southold, New York 11971
JUDITH T.TERRY • TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 14, 1997
/71
Transmitted herewith is a copy of application No. for a Cesspool/
Septic Tank Construction Permit submitted by:
Karol Filipkowski •
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 recommendations:
APPROVE
DISAPPROVE
Comments:
RECEIVED
MAR 2 .
1997
Signture
%Wtho'd Town3//�
Clerk Dated
OFFICE OF THE TOWN CLERK ,��'" ••,
Town of Southold ���''i, FF01.K ) /6
j J
Judith T. Terry, Town Clerk o ��\. •° R CSG Application No. l0
Town Hall, 53095 Main Road •�
Construction c/
P. 0. Box 1179 ;
Southold, New York 11971 yc•,' Alteration
Telephone
'40
(516)
.��Q���•� $10.00 - Residential ✓
(516) 765-1801 1 1 r;, ' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE
APPLICANT NAME: K> oG, `?jt!'Q ws,e /
APPLICANT ADDRESS: 3 & �P (eJ ( S
Co (7 ri,cmc) 4-14()L12 (( 2-(P
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION Os ALTERATION
jcoLA.el '61 //I -
LOCATION MAP: • Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: c
OWNER OF PROPERTY: Z4,pO - X�L7 t t�FOGus � `
OWNER MAILING ADDRESS: 3 O g J'
C pi 1c,Le . e- 11726 -sor27.
OWNER PROPERTY ADDRESS: e- i1P,uVo¢D •&(
C�/ 1 Cry-� S214-0
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TELEPHONE NUMBER OF CONTACT PERSON: / O 42 �/ 0116.5--
TAX
116. -
TAX MAP NO. : Section //Q Block t� Lot gZ •
CROSS STREET: /e
POiNT
BUILDING PERMIT NUMBER CRO S REFERENCE:
Si natui a of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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I am familiar with Nie.$tAS 'FDR APPROVAL
.00 AND CONSTRUCTION OF ACE SEWAGE
disoofiCiell:11
DISPOSAL SYSTEMS FOR SINGLE FAt .Y.RESIDENCt
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watitaill.
Ci 11 r 0PP � permit !o construct. .
. 01041$31161 314*
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#10161141$ kc'k ;ng -ct�• moo, O g9 The locations of wells and cesspools
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SURVEY FOR
�,, �• �- 5 KAROL FIL/PKO WSKI
0 � _,f01 GP �\ AT CUTCHOGUE
pyo ,� TOWN OF SOUTHOLD
c Q. t e Z� SUFFOLK COUNTY, NY.
1000 - rn0 - o5 - 22
CERTIFIED TOS
Scale: 7"= '40' ..
S. LIC. NO. 49618 v KAROL FILlPKOWSKl hih, tatabs~