HomeMy WebLinkAboutPulver, John .,�o��SUF FO�,�co .
JUDITH T.TERRYy1 t4 Town Hall, 53095 Main Road
TOWN CLERK ; y P.O. Box 1179
�- u' Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O ��
ifi 1 Fax(516) 765-1823
MARRIAGE OFFICER ` � � 11
RECORDS MANAGEMENT OFFICER 01 �� " Fax
(516) 765-1800
,s
FREEDOM OF INFORMATION OFFICER o"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1634 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : STANLEY SKREZEC
Address 1 : 50 GULL POND LANE
City St Zip GREENPORT NY 11944
Descripton of Proposed Construction or Alteration
ADDITION OF CESSPOOL 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 PULVER, JOHN
Mailing Address 1 P. O. BOX 471
City St Zip SOUTHOLD NY 11971
Property Address 1 COTTAGE PLACE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 62.00 block 3 lot 15.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 4/22/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
oFF04,:- TLe 5 4
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JUDITH T.TERRY t$_ t�� Town Hall, 53095 Main Road
TOWN CLERK ; y i P.O. Box 1179
P � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
y � ��� Fax (516) 765-1823
MARRIAGE OFFICER 4,1 4�� ,i Telgpl ,n �I -.1800
RECORDS MANAGEMENT OFFICER : 6 :8��
FREEDOM OF INFORMATION OFFICER
MAR 2 0 1.=.,..j
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD E,_�>;� 5,_,
OF Si;
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office /&
DATED: March 20, 1997
Transmitted herewith is a copy of application No. 1701 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Stanley Skrezec for John Pulver •
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 followin recommendation:
APPROVE
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
RECEIVED
S••nature
APR 2 7, 1997 4/'
Date
Southold Town Cfer
OF?ICE 'OF THE TOWN CLERK ""
Town of Southold .''"CAVWire;
Judith T. Terry, Town Clerk ,;'� ` Application No. ��
Town Hall, 53095 Main Road ;G ; Construction
P. O. Box 1179z
Southold, New York 11971 • s i•; Alteration
Telephone = ,� �4 .'•, $10.00 - Residential k'
(516) 765-1801 = l * ,, �', $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 3 'b/ i
APPLICANT NAME: 211A014 y S�rt� .� L
APPLICANT ADDRESS: SD C3�v t Poo C. N‹,
GrtcA/ Fema--/ -Y. t '+
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: � kN �1� � 2
OWNER MAILING ADDRESS:. �Ok -`7
Soo s(r r•) 1 (
OWNER PROPERTY ADDRESS: Cp ( Fat-c-
TELEPHONE NUMBER OF CONTACT PERSON: '] 2Z—
TAX MAP NO. : Section 2 Block 3 Lot
CROSS STREET: k;,J `4e 2s-
BUILDING PERMIT NUMBER CROSS REFERENCE:
Sig atre of A"` icantt
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RECEIVED BY:,�,�� ���/
Tows Clerk's Office
DATE: A7
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