HomeMy WebLinkAboutSekelsky, Eugene ,00 a FO�,,co
JUDITH T.TERRY S Town Hall, 53095 Main Road
TOWN CLERK y Z i P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � y � ���� Fax (516) 765-1823
MARRIAGE OFFICER Q
RECORDS MANAGEMENT OFFICER WO 00.*„.• 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. 1765 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : SCOTT LATHAM
Address 1 : BOX 595
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 #R10-97-0158
Name Of Owner SEKELSKY, EUGENE
Mailing Address 1 11 WADE DRIVE
City St Zip LAKE GROVE NY 11755
Property Address 1 1755 OLD NORTH ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 514.00 block 3 lot 26.005
Cross Street LIGHTHOUSE ROAD
Building Permit Number Cross Reference:
Issue Date: 11/07/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY 41) y< Town Hall, 53095 Main Road
TOWN CLERK
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Z P.O. Box 1179
rrr � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Oy Fax (516) 765-1823
MARRIAGE OFFICER � �f1 �a%�.��1 Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER - .•"J�t'',,�.‘�
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 3, 1997
Transmitted herewith is a copy of application No. 1840 for a Cesspool/
Septic Tank Construction Permit submitted by:
Scott Latham for Eugene Sekelsky
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.
eitlExt
Linda J. 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
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oF I' CE, .11IE TOWN CLERK 11,11q\VF111.4-e
I own or Southold ,
AppliCilii011 Hu, /C L/C-1
huh . Terry, Town Clerk
Town Hall, 5:1095 Main Road Construction._
P. O. (lox 1179 tn
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Southold, HAlterationw York 11971 14'
• • Resident ial.
Telephone
(516) 765- 1001
Non Residential. .
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ToWN Or SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DIST 11 I CT
APPLICAT ION
I Or
CONS]. UCT ION or ALTER AT ION PERMIT
SEPT IC TANK or CESSPOOL
Permit No.
DATE lk 03\_c --"?
APPLICANT NAME: SC-077 1--41-14-041"1"
APPLICANT ADDRESS: ----80y
2 0-,./c4.0 ikci
srp-riccEsspooL?....=") •
-. -culpTioN or: PROPOSED CONSTRUCT ION OR ALTERATION 2s
LOCA TION MAP: Must be attached hereto hofore permit may be Issued.
LOCATION OF PROPOSED CONS 1.RUCT ION OR ALTERA'!" ION :
OWNER OF PROPER TY :
OWNER MAILING ADDRESS: R \.A)Pca.t.:1>r
ro-ve_ ) t
OWNER PROPERTY ADDRESS : 175r OW Nbireo. .
S-6-1/1-140.--6 c N-Y 10'71
TELEPHONE NUM11ER OF CONTACT PER SON(111Y76, c-360/ 61/4))-741"-----c2400
I AX MAP NO. : Section 'CY ((lock 03 Lot • (
CROSS. STREET : 1...-74#rd,,s/
HUMMING PERMIT NUMLIER CROSS REFERENCE :
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jna I ire of Applicant
lai(;EIVFI) DY
TownOffice
DAT
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307.47' , MUST eE USED BY ANY ANO ALL s(P. eyors I. i LI i +, I.y
moi A ��IPOUSH ANOTHER 1�NO N TERMS SUCH NCE N��LAW•NV
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TUT
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WELL T 1.- locations of wells and cesspools
19
4\ 6.3).. shown hereon are from field observations t
o� 'n and or from data obtained from others.
moo_ '90j►L9 1
, F 'P I am familiar with the STANDARDS FOR APPROVAL
.o��'b <j AND CONSTRUCTION OF SUBSURFACE SEWAGE
\ 't .L 9 DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
X46 y and will abide by the conditions set forth therein and on the
\\ l . �� permit to construct.
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co A o. t9 1000 - 54 - 03 - 265
.��- �`, (� SCALE: 1" = 100'
/ Q- OCT 15, 1997
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'� \ti SUFPQI.tC COUNTY DEFARTNlL Tr OF HEALTH'SF ii�7f a. �'t�p+? h �Q�9
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ill'i g► O J PERM'POR APPROVAL Cr Cf 1RiSCT O1. :% i.A �"
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?CI: L; ZZ 130 L6. 0 FAM1U k i ENCE O Vi * f .t }
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DATE l( Z �— }FQ =� �/� A.
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ice '4f�.r: LIC. NO. 496/8
:11 APPROVED i1 p .�0 /_,_•
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ECONIC T 'J T,'P.C.
ld3J f•!61 765 - •• •:�a MAA i vOF BEDROOM3
Pt O. BOX 909
EX^;i' S THREE`i BARS FROM DATE OF APPROVAL 130 TRAVELER STREET
iOUTHOLD, N.Y. 11971