HomeMy WebLinkAboutKoloski, Chester (2) �
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JUDITH T.TERRY ?'1 Town Hall, 53095 Main Road
TOWN CLERK ; y 2 P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS %%%?'
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MARRIAGE OFFICER V4D1
Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER = �.� `�►�0�1�� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER '•v„, •���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1566 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 AN OVERFLOW 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 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 FAWN DRIVE
Building Permit Number Cross Reference:
Issue Date: 11/01/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
gtfF04 "- `• 7 570
JUDITH T.TERRY 1t� ` Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
I Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER �?'� �� �I�' Fax (516) ?65-1823
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: October 29, 1996
Transmitted herewith is a copy of application No. 1631 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.
nature
Date
OFFICE OF THE TOWN' CLERK ,�,'""" -.,,
Town of Southold .•'�1C�001./(C
Judith T. Terry, Town Clerk �‘'s 4 . c%: Application No./6,3(
Town Hall, 53095 Main Road ;� 44' Construction c...-----
P. O. Box 1179 Alteration
Southold, New York 11971 .I rn
Telephone `y0,��0 ��s tr' '�, $10.00 - Residential �
(516) 765-1801 l '�
,i $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 /044, _
APPLICANT NAME: 1 /i
APPLICANT ADDRESS: /1- 93_Z _ _u
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
4:71-9_1_'#___12-.--.1 . •, .per_
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR--ALTEION:
OWNER OF PROPERTY:
A)
OWNER MAILING ADDRESS: SO iS6`.,-- 4-z... .
_________ /„..7„_______
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 96 Sr
TAX MAP NO. : Section 103 Block Lot
_______i_________
CROSS STREET : fr-ftkjit/ 41
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature o p licant
RECEIVED BY: '' r' • /
Town S erk's Office
DATE: j A.
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