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ELIZABETH A.NEVILLE ,�`Z•
coo Town Hall, 53095 Main Road
TOWN CLERK ti P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS v'
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MARRIAGE OFFICER # Fax (516) 765-1823
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RECORDS MANAGEMENT OFFICER : AAl N�I Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1845 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 TWO RINGS TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner ROY C. TAPLIN
Mailing Address 1 1650 BOISSEAU AVENUE
City St Zip SOUTHOLD NY 11971
Property Address 1 1650 BOISSEAU AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 55.00 block 6 lot 20.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 4/16/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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19
ELIZABETH A.NEVILLE •h Gy4% Town Hall, 53095 Main Road
TOWN CLERK p re %% P.O. Box 1179
ti Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS %%‘+4 ,
' �'�� Fax (516) 765-1823
MARRIAGE OFFICER 451, �a �1 Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER -1491 jig
FREEDOM OF INFORMATION OFFICER •' OS'.111
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: April 14, 1998
Transmitted herewith is a copy of application No. 1918 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Roy C. Taplin by S. Skrezec
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 F
* * * * * * * * * * * * *
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.
Signa 4 e
`111`itig
Date
'"'1'‘O ICE OF THE TOWN CLERK ����,,`' 'fOi�'' _ �`�
Town of Southold ��` Ke'0 ' Application No. `I --.;'/
Judith T. Terry, Town Clerk Gyl:
Town Hall, 53095 Main Road Construction
P. O. Box 1179 o ,ii AlterationSouthold, New York 11971 :N �
D
Tele hone ,f► �����' $10.00 - Residential Li
P
(516) 765-1801 = Ol ��, '� $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ •
DATE q L I Y, I 5
APPLICANT NAME: SritAii.ey cLet5-2.6- C-
APPLICANT ADDRESS: St> & SLC. Pc'P- GOK/5 "
fN • - 1 19 VS/
SEPTIC CESSPOOL Z/--
DESCRIPTION
�DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION 4V0 2-15' (X q i
A1 S ID 4vt.e g e L c.7 S. 4,. .
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTIONOR ALTERATION:
OWNER OF PROPERTY: *y C. L,�N
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OWNER MAILING ADDRESS: j �e-ock‘-r R/ 4"
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OWNER PROPERTY ADDRESS: S 4-w•ill fA S 41tIy-r
TELEPHONE NUMBER OF CONTACT PERSON : 4 7 7 " l 8 ZZ
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TAX MAP NO. : Section .) Block L, Lot ,-... L
CROSS STREET: I Z S---
BUILDING PERMIT NUMBER CROSS REFERENCE:
7
Sign tPeYAI:dil-c;nt
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To n Clerk's Office
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