HomeMy WebLinkAboutVerostek, Conrad •0k `
•�;oCit. 5If o re's
Town Hall, 53095 Main Road
41 o•O ir P.O. Box 1179
141:"w! ala � _ Southold, New York 11971
JUDITH T.TERRY •.��• TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR 01 VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1592 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : P. O. BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner VEROSTEK, CONRAD
Mailing Address 1 415 MILL CREEK DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 415 MILL CREEK DRIVE
City St Zip SOUTHOLD NY 11071
Tax Map No. section 135.00 block 3 lot 30.001
Cross Street NORTH ROAD
Building Permit Number Cross Reference:
Issue Date: 3/17/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
1 L5 �S511 117
• ��gVFFO��=c
0 "', ► 1 1997
JUDITH T.TERRY ����� 1."...11%
� Town Hall, 53095 Main Road
TOWN CLERK i r �'��� �Box 1179
h '�'•1tr ry� p , 7.
ivw �� uthMd,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER `y o���� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER �lAge *poi�� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER '•v,• ,•�� '
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: March 11 , 1997
Transmitted herewith is a copy of application No. 1687 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Conrad Verostek •
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 re mmendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
RECEIVED
MAR 17 1997 Signature /
3 l
Southold Town Clerk
Date �7
THE.
OFFICE OE THE TOWN CLERK ,,,'""""'%,
Town of Southold ��FFOCIY`►. /r !f 7
Judith T. Terry, Town Clerk ;' '0 �l/ : Application No. °
• ��
Town Hall, 53095 Main Road !� ; Construction
P. 0. Box 1179 ; v rn ; Alteration
Southold, New York 11971 to
Telephone `y0 �o''1 $10.00 - Residential
(516) 765-1801 - �'01 0�
. �
,, $25.00 - Non-Residential•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ J
DATE oT / j / / `7
APPLICANT NAME: � �''�-'Z�?A�L r ' 16-,
APPLICANT ADDRESS: 4,e 5ir-/ 77"2
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY : L-!24
OWNER MAILING ADDRESS: jiVr. X
OWNER PROPERTY ADDRESS: "! / JhV., .= -- ..- �j `
TELEPHONE NUMBER OF CONTACT PERSON: d - 96 S '
TAX MAP NO. : Section /3 5"' Block 3 Lot 30,
CROSS STREET: n_d. '
BUILDING PERMIT NUMBER CROSS REFERENCE:
1..//
Signature of A Iicant
RECEIVED BY : RigiqI€i
Town Clerk's fif �""
DATE: MAR 1 A _.
town Clerk Southola
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