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ELIZABETH A.NEVILLE
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G.y Town Hall, 53095 Main Road
TOWN CLERK1:44P.O. Box 1179
2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Prt
Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER �Ol �� � Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER •sot,���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1921 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 WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner ZORN, BOBBIE
Mailing Address 1 (COTTAGE AT PORKY'S RESTAURANT
305 NORTH ROAD
City St Zip GREENPORT NY 11944
Property Address 1 305 NORTH ROAD
City St Zip GREENPORT NY 11944
Tax Map No. section 35.00 block 1 lot 22.OQ0
Cross Street SOUND ROAD
Building Permit Number Cross Reference:
Issue Date: 8/25/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ,�$ Gy Town Hall, 53095 Main Road
TOWN CLERK p 1 P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER 19l *�0�. Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: August 21 , 1998
Transmitted herewith is a copy of application No. 1996 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Stanley Skrezec for Bobbie Zorn, formerly Porky's Rest. , R. Sledjeski
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.
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Date
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OFFICE OF THE TOWN CLERK
`;
Town of Southold �FQ(
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ;��O G�►; Application No. �Q,6
P. O. Box 1179 < _ .2m ; Construction
Southold, New York 11971 ttr3 Alteration
(516)le
5 6)le7 5�1801 ne
.�1���! $10.00 - Residential
Teph • ~is° ' $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 4 ? i-sfzi, S 8
APPLICANT NAME: •� - , ,
APPLICANT ADDRESS: _ • (,L,(„ p •� ,_
SEPTIC CESSPOOL ✓
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
4-1111) Ce.zweec
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: � _ N — PrperMite
_ ( / " etttale-s
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: Ll
TAX MAP NO. : Section S Block
Lot
CROSS STREET:
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BUILDING PERMIT NUMBER CROSS REFERENCE:
S aur of Applicant
RECEIVED BY 1-(
Town Cle Office
DATE: ���
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