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Home My WebLink AboutWorysz, Gerard /''�,� OOFFO11-Ce JUDITH T.TERRY � � 'yam 1 Town Hall, 53095 Main Road TOWN CLERK o < P.O. Box 1179 Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICS O �, Fax(516) 765-1823 MARRIAGE OFFICER \** �Q�',�� Telephone (516) 765-1800 FREEDOM ORECORDS F INFORMATIONNOFFICER -NAGEMENT OFFICER 1 o s�'� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1487 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : MAINSAIL CONSTRUCTION CORP Address 1 : P. O. BOX 1376 City St Zip SOUTHAMPTON NY 11969 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. SCHD REF #R10-96-40 Name Of Owner WORYSZ, GERARD & JEAN Mailing Address 1 12 HAYES ROAD City St Zip AMITYVILLE NY 11701 Property Address 1 175 CLEARVIEW AVENUE City St Zip SOUTHOLD NY 11971 Tax Map No. section 70.00 block 8 lot 40.000 Cross Street GARDINER'S LANE Building Permit Number Cross Reference: ka- — Issue Date: 6/07/96 Judith T. Terry Southold Town Clerk 1'1_et J a.a . (TOWN SEAL) 'o,#.e Of F04 � JUDITH T.TERRY y1 Town Hall, 53095 Main Road TOWN CLERK ; y i tP.O. Box 1179 ..- Pr, $ Southold, New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER .y1 Fax (516) 765-1823 RECORDS MANAGEMENT OFFICER ‘-:491 * sO o� 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. 1487 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : MAINSAIL CONSTRUCTION CORP Address 1 : P. O. BOX 1376 City St Zip SOUTHAMPTON NY 11969 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. SCHD REF #R10-96-40 Name Of Owner WORYSZ, GERARD & JEAN Mailing Address 1 4 FEUX PLACE City St Zip AMITYVILLE NY 11701 Property Address 1 175 CLEARVIEW AVENUE City St Zip SOUTHOLD NY 11971 Tax Map No. section 70.00 block 8 lot 40.000 Cross Street GARDINER'S LANE Building Permit Number Cross Reference: Issue Date: 6/07/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) ool stFFOLA,z- / / l O JUDITH T.TERRY � _ yt Town Hall, 53095 Main Road TOWN CLERK y Z P.O. Box 1179 '11 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS •ji MARRIAGE OFFICER � � O � •� Fax (516) 765-1823 : RECORDS MANAGEMENT OFFICER 91 * Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER ,••�� OFFICE OF THE TOWN CLERK r n;, TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's OfficeEt -�------ w_._ Tom, t.-,. DATED: May 29, 1996 _..LL --- Transmitted herewith is a copy of application No. 1552 for a Cesspool/ Septic Tank Construction Permit submitted by: Mainsail Construction Corp. for Gerard 6 Jean Worysz 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. Linda J. Cooper * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: ,5c7/ /I l� *-7'41.6) Ar ;iii, e Signature Date I OFF'ICE OF THE TOWN CLERK ,o" ' '•, Town of Southold ••sl'e \ OLA'r� Judith T. Terry, Town Clerk ••• %�: &,(..1;_ Application No. i� Town Hall, 53095 Main Road �� 1. �f. �C . �.,. � t Construction P. O. Box 1179 tom .: 6 • Southold, New York 11971 1tor) �� • yc = Alteration :yam �' •• $10.00 - Residential `� Telephone .�"�0 �.a� �� (516) 765-1801 . .I !it ' - ..rt �� $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 APPLICANT NAME: 111 l RIr./s,1-iL co osTrtfiliateV Cv2P• APPLICANT ADDRESS: e-P, Q •.- ,c 1fl u 11°i Log SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATIONto � LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:/ _ OWNER OF PROPERTY: . V /�1 �Z ""�� • OWNER MAILING ADDRESS: `F.Ku )( �\Ace lkilik Crph uZ 1\1`f MO 1 OWNER PROPERTY ADDRESS: / 7 C-e'G----GK.c, ,k_ TELEPHONE NUMBER OF CONTACT PERSON : (5162) 4 + 1121, 620 TAX MAP NO. : Section 610. 00 Block 08.00 Lot 01-1(:) . 00Z) CROSS STREET: C-s tt•f'61tc-z ks 4 BUILDING PERMIT NUMBER CROSS REFERENCE: i 1 • C...,Q2)----- Signatur f Applicant RECEIVED BY : ///.+________ Town Clerk's Office DATE: —.... ..4.,v_. ltst t1p$Ji %S .%• D M� -ty4.q�� ,b, T4.1117 bvR.t�w�s 4,.�EB.TtG6.1.: „''' . ,, • w%NcbA%T.., 'baa• •c T\3%U, .Tr A4t-4‘•. 4 Ellif��, -1,) ,Rr 4.44 V 1.'e.47�+R'a A.qt ly .�U IDN 4.i..01.4 I ��yy �Oc.1.�. t1 A►VV M. Z ' /i.pe Tie*i( `1w 4.6.;.11 J Al S fy �yy0sf •b) 5 IPlir O‘...Ni. C.44 u.) Ty :.K. M %,P' ep vb-r, t acao - 6 Lc• a'6.°,o© DEPT. OF, - b`w... eBs,oa - u.oT Q4o. oc:Po 6.0 u.it,6 SRROII° • , WATE ; ' ► SEWAC DISPOSAL SYSTEMS MUST CONI+ORN NEW STANDARDS pATED OVEmBER 13,1! !54. 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SYotf.MS 1r04114. *%NAL,44.6.- p pA► Tlkg 1•^A. ~tas o4 lit 1.1CIV % €.1r4 POs CI.V. . p kh.ii, O ba&b i t‘...s o A,1Jto.a,%9s.+ _ s tV A�`Q 18).1. Vll,+.AW. R .1.6A dit 1: \\..`( Ca-la a-16•Sio * 4.-4 s6. S” ,..PO W‘‘444.4.4 III* .Pi. ihrtTfvtaaNLy ttlot R,,k; ry ok nUDITIUis 4.1,4,�opsi4ME ! els.MttToc..01.4 tor ;f1i•t TO THIS SURVEY IS A VIOLATION OI k., t�`. r P` SECTION 7209 OF THE NEW YORK STATE O. ►4 c.4.101.14.4.101.14.5, 5 t c. l•0LTVQ.E ,; t ' Q EDUCATION_LAW, " t; 1A% r 0 F S 0 U 1 M 1✓�Q COPIES OF THIS SURVEY MAP NOT BEARING `'.5 Ft�'O' c°.SO 1 ' /. �,I,1 EHE LAND MBOSSFD SEALSURVEYOR'S SHALL INKED SEAL OR ERED L• �! TO BE A VALID TRUE COPY. rye♦ COUNTY DEPARTMENT D.�-' �p�Y�OF - - GUARANTEES INDICATED HEREON SHALL RUN SVFFOLIK CONN a,i DE."A THEN a HEALTH SERVICES ! 4. OEJIY TO THE PERSON fOR WHOM TME SURVfBI ��>, * ��, A K t� f~� 1 IS PREPARED AND ON MMEP HALF TO THE ''' gt:gNU1�I�1>�. 1\I �� ,. TITLE COMPANY,GOVERNMENTAL AGENCY HERMIT FOR APPROVAL C.P'CONSTRUCTION FOR A t A urFDINO INSTITUTION LISTED HEREON, AND S CL PPA LY RESIDENCE ONLY -01‘..N.106 R got bet 4:0• TO THE ASSIGNEES OF THE LENDING INSTI+ �/�'��+�Q�Q ' y '41414 „.*ik .444,-Bibi. DAWN. GUARANTEES ARE NOT TRANSFERAB Alai S I7J F. O. .p11,�Q wF � *7”'411�" � /t9 A1aDI410NA� INSTITUTIONS OR SUBSEQU J 'log,aft 4.41 1't.►4 46.►►" ' '0 T 41. A,l e 1. X a"t 11t�w ►� PPR01iF.D • FOR MAXIMUM OF , BEDROOMS .' Ci 4�14114 w.1,T1i,E.4•T O'• CREW.W.A�c.P 4. e x� W v a"`�S'Z„ . To 1 Lott °w N•'1 EXPIRES THREE YEARS FROM DATE OF APPROVAL a 6T #4 , ,.R,,1cs0J T�St_t IN► S moi• , • • ! . Q y I x'