HomeMy WebLinkAboutNelson, Ann FFO(�-�o
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JUDITH T.TERRY t�_ yet• Town Hall, 53095 Main Road
TOWN CLERK ; y i • P.O. Box 1179
Pr/ Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ��� Fax(516) 765-1823
MARRIAGE OFFICER �;�f� a�����
RECORDS MANAGEMENT OFFICER _ 1 l [ �` � 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. 1462 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : STANLEY F. SKREZEC
Address 1 : 40 GULL POND LANE
City St Zip GREENPORT NY 11944
Descripton of Proposed Construction or Alteration
ADDITION OF TWO DRAINAGE RINGS TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner NELSON, ANN MARIE
Mailing Address 1 1420 NINTH STREET
(CHERRY LANE FARMS)
City St Zip GREENPORT NY 11944
Property Address 1 1420 NINTH STREET
(CHERRY LANE FARMS)
City St Zip GREENPORT NY 11944
Tax Map No. section 45.00 block 6 lot 9.000
Cross Street BROWN STREET
Building Permit Number Cross Reference:
Issue Date: 4/18/96 Judith T. Terry
Southold Town Clerk
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JUDITH T.TERRY 6 = y� Town Hall, 53095 Main Road
TOWN CLERK • N = • P.O. Box 1179
• n► $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
y ���1v Fax(516) 765-1823
MARRIAGE OFFICER �f� 40•��� Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER . ' ixt ••
FREEDOM OF INFORMATION OFFICER .0.
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: April 15, 1996
Transmitted herewith is a copy of application No. 1522 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Stanley F. Skrezec for Ann Marie Nelson .
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 - f/
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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Date
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TOWN • ..•. 11L•. b
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OFFICE OF'THE TOWN CLERK ,.,,""""'
Town of Southold .01,cAMILK
Judith T. Terry, Town Clerk �' � ��Gy Application No./ Sol
Town Hall, 53095 Main Road Z G; Construction
P. 0. Box 1179
Southold, New York 11971 •c=n �'�•' Alteration
Telephone -00. Q? $10.00 - Residential
(516) 765-1801 '. "1 ��
- � f' $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 VAS-1%
APPLICANT NAME: St j L- ' F.
APPLICANT ADDRESS: .S &-v(k tPQe•d
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SEPTIC
' y -SEPTIC CESSPOOL K
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION 4 D
2- 9(taiw C9a- CeS seoL
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: / jN g /11,#ciCE
OWNER MAILING ADDRESS: ( Li 2_ 0 a a yvy L o.c r s
CvPQiu Ott
OWNER PROPERTY ADDRESS: (n,,p
TELEPHONE NUMBER OF CONTACT PERSON: Li I 1 ` ( Qj 2 2.,
TAX MAP NO. : Section y 5- Block Lot Jr
CROSS STREET: o v C vw\i
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
Si nature of Aq•licant
RECEIVED BY:
Town Clerk's Office
DATE: y, /5- -
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