HomeMy WebLinkAboutHuzsek, Andy ELIZABETH A.NEVILLE /h OGy�! Town Hall, 53095 Main Road
TOWN CLERKoo
Z P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS VI
MARRIAGE OFFICER
�'�Ol �I Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER _ �9-001Agt Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER �� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3169 R Residential x Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : INLAND HOMES INC
Address 1: PO BOX 117
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR ONE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-03-0043
Name of owner HUZSEK, ANDY & ROBIN
Mailing Address 1 870 CHAMPLIN PLACE
city St Zip GREENPORT NY 11944
Property Address 1 535 MCCANN LANE
City St Zip GREENPORT NY 11944
Tax Map No. section 33.00 block 3 lot 32.000
Cross Street SUTTON PLACE
Building Permit Number Cross Reference:
Issue Date: 4/15/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE /�'_ Gy ; Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
y Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS t`.°4
�
MARRIAGE OFFICER
'F �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER _y�Ql Jgg �ali��, Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
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APR , 2114 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 15, 2004
Transmitted herewith is a copy of application No. 3307 for a Cesspool/Septic Tank Construction
Permit submitted by:
Inland Homes for Huzsek
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: ...A4a-":P'yre-40""f=4";--
7/"(Ae...zer ,
Signature
Dated
f FF CE OF THE TOWN CLERK
Town of Southold
Application No.
Judith. T. Terry, Town Clerk PP 3307
Town Hall, 53095 Main Road Construction
P. O. Box 1179
Southold, New York 11971 Alteration
Telephone Residential xxxx
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE 3/12/04
APPLICANT NAME: Inland Homes
APPLICANT ADDRESS: PO Box 117,Mattituck,N.Y. , 11952
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
New single family dwelling
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Andy & Robin Huzsek
OWNER MAILING ADDRESS: 870 G,A.,,p _p(
OWNER PROPERTY ADDRESS:' McCanns Lane,Greenport
TELEPHONE NUMBER OF CONTACT PERSON: 298 %6A6
TAX MAP NO. : Section 33 Block 3 Lot 32
CROSS STREET: Corner of McCanns lane and sutton place
BUILDING PERMIT NUMBER CROSS REFERENCE: pending
Signatur•'o"ppiicant
RECEIVED BY: 12/505:24).UA..
(0 Town Clerks Office
DATE:
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