HomeMy WebLinkAboutSkwara, Chester %
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Town Hall, 53095 Main Road
e• 0 Obi P.O. Box 1179
111 ►Olsit Ngtrj, Southold, New York 11971
JUDITH T.TERRY 1 �.\�� TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR Of VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1706 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : GARY TABOR
Address 1 : 680 NAVY STREET
City St Zip ORIENT NY 11957
Descripton of Proposed Construction or Alteration
ADDITION OF CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner SKWARA, CHESTER
Mailing Address 1 3720 WELLS ROAD
City St Zip PECONIC NY 11958
Property Address 1 3720 WELLS ROAD
City St Zip PECONIC NY 11958
Tax Map No. section 86.00 block 1 lot 14.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 7/30/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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in Town Hall, 53095 Main Road
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Q O� P.O. Box 1179
4sit *tz° Southold, New York 11971
JUDITH T.TERRY `•�� TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: July 30, 1997
Transmitted herewith is a copy of application No. A1779 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Gary Tabor for Chester Skwara
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 -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQU I RED.
ignatu�
30 q -/
Date
OFFICE OF THE TOWN CLERK ""
Town of Southold .'',%If OUrl►.
Judith T. Terry, Town Clerk ;' Application No. A )77
Town Hall, 53095 Main Road :C Construction
P. 0. Box 1179 _ = Alteration
Southold, New York 11971 • en .ZTc ; L..0
Telephone `y�,y'y0 Ib���' $10.00 - Residential
17
(516) 765-1801 = l 1 ,, I'' $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCT ION or ALTERAT ION PERMIT
•
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE ?/ C7 )? 7/
APPLICANT NAME: /9r
APPLICANT ADDRESS: "
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SEPTIC CESSPOOL f--
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST)UCTION OR ALTERATION:
OWNER OF PROPERTY: ('' -� c' 7t1-^ S /fw )' i-, ici
OWNER MAILING ADDRESS: 7 �L0 (� - ,1/ )��/
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OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 3 23 P-6 6 7
TAX MAP NO. : Section l . Block / Lot ) <-1/
CROSS STREET:
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BUILDING PERMIT NUMBER CROSS REFERENCE:
....___A ,. ,...7,-/-,-,____
Sicature of Applicant
RECEIVED BY: /6 AIR "./
Town Clerk's Office
DATE: 7/3 ,6177
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