HomeMy WebLinkAboutKoloski, Chester �,,„
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JUDITH T.TERRY ',•�� tlN Town Hall, 53095 Main Road
TOWN CLERKk P.O. Box 1179
Pry Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER \=y Fax(516) 765-1823
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RECORDS MANAGEMENT OFFICER =�l J ' •,• Telephone (516) 765-1800
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. 1746 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 WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner KOLOSKI, CHESTER
Mailing Address 1 2250 BEEBE DRIVE
City St Zip CUTCHOGUE NY 11935
Property Address 1 2250 BEEBE DRIVE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 103.00 block 3 lot 9.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 10/09/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY � _ 'A Town Hall, 53095 Main Road
TOWN CLERK y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O r Southold, New York 11971
Fax(516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER \.749./ �� 1�, Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER oft 8 ;-
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: October 6, 1997
Transmitted herewith is a copy of application No. 1821 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Chester Koloski
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
/ignatur
0 CT _. 8 1997 tiv t
Date
Southold Town Clerk
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•OFFICE OF THE TOWN CLERK ""'
Town of Southold .,''1��FFO[Kc�
Judith T. Terry, Town Clerk �G = Application No. / ./
Town Hall, 53095 Main Road Construction tom/
P. 0. Box 1179 s `
Southold, New York 11971 5,7 Alteration
TelephoneO' ��• ' $10.00 - Residential ��
(516) 765-1801 y�l '
,�,,, ' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. k
Fee $
DATE /0/10/97
APPLICANT NAME: , g"--79--/
APPLICANT ADDRESS: /d .__ 97Z--
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
C_l e.€4,(4-7,-( /ZOO-' ic _.7-
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTI NOR ALTER TION:
OWNER OF PROPERTY: �.
OWNER MAILING ADDRESS: C>19-570 i e
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OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: Of?: 96 ST
TAX MAP NO. : Section /O3 Block \2 Lot 9
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature of App!' ant
RECEIVED BY:
Toinynclerk's Office
DATE: t /9 N f?
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