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HomeMy WebLinkAboutPriculik, Joseph , • ��$OFFOLt JUDITH T.TERRY tl= y1 Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 $ Southold, New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER �'� o• �I�' Fax (516) 765-1823 RECORDS MANAGEMENT OFFICER �l �0od 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. 1502 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 PRILUCIK, JOSEPH Mailing Address 1 718 CLARENCE AVENUE City St Zip BRONX NY 0000 Property Address 1 320 EUGENES ROAD City St Zip CUTCHOGUE NY 11935 Tax Map No. section 97.00 block 6 lot 3.000 Cross Street MAIN ROAD Building Permit Number Cross Reference: Issue Date: 6/28/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) J?7'Cr ? x22 /s7 t f���S�FfO(Ke ►O� y� Town Hall, 53095 Main Road JUDITH T.TERRY ► TOWN CLERK P.O. Box 1179 xb 4 Southold, New York 11971. REGISTRAR OF VITAL STATISTICS (� Fax (516) 765-1823 MARRIAGE OFFICER .y4 0! >' RECORDS MANAGEMENT OFFICER , el �� � Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER Z7xz,�-rll''l ► OFFICE OF THE TOWN CLERK . �; P ;�J� TOWN OF SOUTHOLD ` I JUN 27 iqa TO: Southold Town Building Department FROM: Linda Cooper, Southold Town Clerk's Office BLDG. DEiYT. TOWN OF SOl1THOL t DATED: �.�.�.���.� �.�.0 June 26, 1996 Transmitted herewith is a copy of application No. 1567 for an ALTERATION PERMIT for a cesspool or septic system submitted by Peconic Cesspool for Joseph Prilucik . 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 - 47 DISAPPROVE - COMMENTS : Maintain required setbacks from adjacent wells, buildings, property lines and water bodies. EXCAVATION INSPECTION REQUIRED. (--- - -.. ,t,at./9_, —1:1;..e„(- ___ Sign tures/ v,.,-. 6,A Dat • OFFICE OF THE TOWN' CLERK �,o,"" Town of Southold yet C' �,., C' - , .0 V _ Application No. , >ty /. Judith T. Terry, Town Clerk �' Town Hall, 53095 Main Road �' iL Construction L____.- ; -- P. O. Box 1179 Mi ` Alteration Southold, New York 11971 w �� _.__.____ _____._.___. t. 0 e'1 $10.00 - Residential v Telephone , : .�' .ate .� (516) 765-1801 '- "1 ' $25.00 - Non-Residential TOWN OF SOUTHOLD. SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICAT ION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ DATE APPLICANT NAME: '. ,. ,,�.L _ _ __— APPLICANT ADDRESS: P.b a __ q''_�� ` „ V - __4�__ _ _ . SEPTIC CESSPOO(Y DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: a e- Per hi C I._ 1-.7. OWNER MAILING ADDRESS: 1 1 % CI t4--a. u.--&.) c+- Au c 3 ( G-e ei,5 red — -.ia-© N_X- PJ .5t-- (( OWNER PROPERTY ADDRESS: 1Y ') TELEPHONE NUMBER OF CONTACT PERSON: s�Cf,c---- q(,, c - TAX MAP NO. : Section Block Lot .3 95S-&TREET BUILDING PERMIT NUMBER CROSS REFERENCE: ___________a;_4_ _____ _ 1k t A . Signature o ApplicaI RECEIVED BY : Town Cierk's office - - DAT E: .. . ---- __- i cf2AA7,/- 1 - i 41,GT/ ----- rd '-------' ,P 0101 ( ass prD I t‘l 0-kit-ikr ,r,u,