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ELIZABETH A.NEVILLE n% yc , Town Hall, 53095 Main Road
TOWN CLERK t ti Z P.O. Box 1179
Pvi
Southold,New York 11971
REGISTRAR OF VITAL STATISTICSy� 0'l/� Fax(516) 765-1823
MARRIAGE OFFICER _— 49,E .00.0 Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
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. 1909 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : FRANK R. KRUSZESKI JR.
Address 1 : P. O. BOX 1411
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 #R10-95-0066
Name Of Owner KRUSZESKI, FRANK R. JR.
Mailing Address 1 P. O. BOX 1411
City St Zip SOUTHOLD NY 11971
Property Address 1 325 LIGHTHOUSE ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 54.00 block 3 lot 26.006
Cross Street OLD NORTH ROAD
Building Permit Number Cross Reference:
Issue Date: 8/13/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
y
Al' /�,O��S�FFO(�co _
` ELIZABETH A. NEVILLE t'h`1` -t4_,N
Town Hall, 53095 Main Road
TOWN CLERK y -�, % P.O. Box 1179
% 2 . Southold, New York 11971
REGISTRAR OF VITAL STATISTICS %%06
�'� Fax (516) 765-1823
MARRIAGE OFFICER � 4. �\.�°I Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER : �1 �a,.��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 3, 1998
Transmitted herewith is a copy of application No. 1985 for a Cesspool/
Septic Tank Construction Permit submitted by:
Frank and Lauren Kruszeski •
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 1
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE ,/
DISAPPROVE
Comments:
S.iinatur
Dated
it
OFFICk OF THE TOWN CLERKc,VFFOL,rC
Town of Southold No./ !'S'
Judith T. Terry, Town Clerk Application
Town Hall, 53095 Main Road r Construction !7
P. 0. Box 1179 criY.
Southold, New York 11971 O � Alteration
Tele hone 701_ Ne Residential
p
(516) 76571801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE g .4qe
APPLICANT NAME: etittnieW � <ruszes6
APPLICANT ADDRESS: � X. It-FI
cow--1/1o16( y ( ((I I
SEPTIC ✓ CESSPOOL
DESCRIPTION OF PROPO ED CONSTRUCTION OR ALTERATION
h ) d �►u� (I r l
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ClAt. 1-ztnk f 'Krosies °J'
OWNER MAILING ADDRESS: Pe) 60X 1t-Ik0
SO ul o t( tic- c cq 1) ,
OWNER PROPERTY ADDRESS: 32� L-91/1r7IOUS�_ 14
.>O1,c.Tho cc&
TELEPHONE NUMBER OF CONTACT PERSON: 5(t„9-76.S .- 150 p LRurell
TAX MAP NO. : Section �j Block 7 Lot • •
�a
CROSS STREET: old I k9r h t
BUILDING PERMIT NUMBER CROSS REFERENCE:_.
4./jA 4 /
/j Sign re of .,•:plicant
RECEIVED BY: 41 AZetCAL-,1,Le
Town Clerk's Office
DATE: /�i
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HEALTH
DEPT. OF
- e - ! HEALTH SERVICES
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