HomeMy WebLinkAboutKrudop, Kelly •
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3296 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ROBERT KRUDOP
Address 1: PO BOX 1042
City St Zip NATTITUCK NY 11952
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. REF #R10-04-0104
Name Of Owner KRUDOP, KELLY
Mailing Address 1 PO BOX 1042
City St Zip NATTITUCK NY 11952
Property Address 1 250 TUTHILL ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 96.00 block 1 lot 9.000
Cross Street ROUTE 48
Building Permit Number Cross Reference:
Issue Date: 5/18/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
114
',,..,--
ELIZABETH A. NEVILLE lQ � Town Hall, 53095 Main Road
TOWN CLERK * *; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS N Southold, New York 11971
MARRIAGE OFFICER Fax
Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ��', ��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER CIOUNT`I southoldtown.northfork.net
r OFFICE OF THE TOWN CLERK
FEB 2 2 TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 18, 2005
Transmitted herewith is a copy of application No. 3437 for a Cesspool/Septic Tank Construction
Permit submitted by:
Robert Krudop
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:
Signature
`S—
Dated
Y t a
' ea-•
‘'ItsT VI Town Hall,53095 Main Road
TOWN CLERK i . 1 P.O.Box 1179
REGISTRAR OF VITAL STATISTICS j* Southold,New York 11971
MARRIAGE OFFICER VO V$ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ' •.1 Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER _'�e'� it southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
1
Residential @$10 or Non-Residential @$25 Application No3 3
Permit No.
Applicant Name '------ a\>2-14 ) 3
Applicant Mailing Address t?i 0, (0 V 1
A +hs-kt.%., LSI' IfSZ
Septic Tank or Cesspool ✓
Brief Description of Proposed Construction or Alteration ---4,,;\ l4 ---
Location of Proposed Construction/Alteration:
Owner of l(fiLf
Owner Mailing Address: -Po &x /0Y -
M ,--+ki J /4 ,ICC—Z-
Owner Property Address: .rk+r 12
)3(3° (o2.4%.,
Name and phone number of contact person ---4:103-4 ,(,x, d2C(�`7US G l-z7s }G
Tax Map No: Section 9E Block 1) 1 Lot 01
Cross Street —F 4
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH - TH DEP I NT APPROVAL
,",,. /
Signature of Appl / D iZ /057-
Received by: -4()
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t . . 'FO . COUNTY, NEW, YX
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