HomeMy WebLinkAboutKrukowski, Todd e ;Np iii
11 OFFOL,(
ELIZABETH A.NEVILLE $�`Z Town Hall, 53095 Main Road
TOWN CLERK p _< Y P.O. Box 1179
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Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
gait. Fax (516) 765-1822
MARRIAGE OFFICER �‘#* 0. � Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER Ol
• •
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1809 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PETER JOHNSTONE
Address 1 : P. O. BOX 91
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 #R10-97-0183
Name Of Owner KRUKOWSKI, TODD
Mailing Address 1 MAIN ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 KRUKOWSKI, TODD
MAIN ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 56.00 block 3 lot 13.002
Cross Street BAY HOME ROAD
Building Permit Number Cross Reference:
Issue Date: 2/11/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
` 0°ii�OFFOL,�co
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ELIZABETH A.NEVILLE t, Gym%�` Town Hall, 53095 Main Road
TOWN CLERK ; p -d , P.O. Box 11.79
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax*" It Fax (516) 765-1823
MARRIAGE OFFICER ,, 0��0 Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER ,,,y) A.iNg 4
FREEDOM OF INFORMATION OFFICER00
A,dr 104-
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 9, 1998
Transmitted herewith is a copy of application No. 1883 for a Cesspool/
Septic Tank Construction Permit submitted by:
Todd Krukowski by Peter Johnstone .
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.
Lind��Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments:
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Dated
• -
1.1/11 ° - •
lijounitecN
OFFICE OFTHE FOWN CLERK )01 c0114,,
FowiiiSouihoIcJ Application Ho.
indult T. Tarry. Town Clerk
rowo 53095 Main Road Construction
in •••
I'. O. Ilux 1179
0 Alteration
Southold, New York 11911 1
. . . . .
Telephone (1.
* • Residential
.'1171111trirf
(516) 165- HMI Non •Residential. . ... . .. .
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER Dispo'sAL Dis-rutc-r
AppLicATIoN
I iii
C ON ST R UCT ION Or ALTERATION PERMIT
SEPTIC l'ANK CESSPODI.
POI•MD
•;?0,•
Eel!
•
DATE
APPLICANT NAME: 72;74,0 jeUge2141,..57 /
APPLICANT ADDRESS: 444±tJ geTe/77710Z,4 Z906
SEPTIC CESSPOOL
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DESCRIPTION OF PROPOSED CONST ItLJCT ION OR A LT ER A T ION
•- •
. . . . .. ..._.
LOC:A.110N MAP: Must be attached hereto holore permit may be issued.
• LOCATION OF PROPOSE() CONST RUCT ION OR A LT ERAT ION
OWNER OF PROPERTY
OWNER MAILING ADDRESS: 4 .51/A./4.9/),
OWNER PROPERTY ADDRESS
•
...
TELEPHONE NUMBER OF CONTACT PERSON: Zr, 5130q
TAX MAI' NO. : Section .5-6 Lot
CROSS STREET 5 .
e
..
BUILDING PERMIT NUMBER CROSS REFERENCE :
•
5-55 .- --e-.Ca-571i
RECEIVED I3Y : I / •
• REcgito c orios Office
DATE :
FEB q1993
Southold Town Clerk
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