HomeMy WebLinkAboutWieczorek, Robert e i'egFOLit
\Ou co
JUDITH T.TERRY y< Town Hall, 53095 Main Road
� o
TOWN CLERK y 2 i P.O. Box 1179
ivyREGISTRAR OF VITAL STATISTICS i! Southold, New York 11971
MARRIAGE OFFICER �0 �0� /� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER 1 *
m' Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER — • 0"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1744 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL SERVICE
Address 1 : 2760 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
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 WIECZOREK, ROBERT
Mailing Address 1 50 OAK STREET
City St Zip SOUTHOLD NY 11971
Property Address 1 50 OAK AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 77.00 block 2 lot 5.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 10/02/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
... ,
,..
,"
v 0����gUf FO�,�co
O / -7,(y
,'
JUDITH T.TERRY 11_1 ***41 Town Hall, 53095 Main Road
TOWN CLERK % y .c% P.O. Box 1179
REGISTRAR OF VITAL STATISTICS , p �'�i Southold, New York 11971
v; � Fax (516) 765-1823
MARRIAGE OFFICER O,1
RECORDS MANAGEMENT OFFICER 01jii .080I Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ‘1'••~,..--
••~, /01
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department 1 DY--
,\ril
1)
FROM: Linda Cooper, Southold Town Clerk's Office 060
DATED: October 1, 1997
Transmitted herewith is a copy of application No. 1818 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool Service for Robert Wieczorek .
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 followi recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
ignature
/0//-/i7
Date
OFFICE OF THE TOWN CLERK ,,,,'",,"
Town of Southold ' �FfOIK ��/�
Judith T. Terry, Town Clerk Ol/y�'0� Application No. l
Town Hall, 53095 Main Road Z !�• l
Construction
P. O. Box 1179
Southold, New York 11971 J. Alteration
Telephone ,> �0. '
$10.00 - Residential
(516) 765-1801 01
,, $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ g
DATE Ods / / l?
APPLICANT NAME: A/4'S
APPLICANT ADDRESS: 2X° A�/IJ/TC� ct
SEPTIC CESSPOOL
DESCRIPTION OF P)y •SED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY :
OWNER MAILING ADDRESS: Sa
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: fy,) )
TAX MAP NO. : Section 77 Block Lot S�
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
` Z -17 .
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: r0 2
r
C V
ky�
P:r1c