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HomeMy WebLinkAboutGerowski, Doug /i*oF Soo _ ELIZABETH A.NEVILLE,RMC,CMC � O : Town Hall, 53095 Main Road TOWN CLERK ,� *, P.O. Box 1179 REGISTRAR OF VITAL STATISTICS N ,e % Southold,New York 11971 MARRIAGE OFFICER ��� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER �1 Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER =yCOU ,�,,,1� ' 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. 3900 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : PECONIC CESSPOOL Address 1: P 0 BOX 487 City St Zip LAUREL NY 11948 Descripton of Proposed Construction or Alteration ADDITION TO EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner DOUG GEROWSKI Mailing Address 1 89 BROOK CT. S. City St Zip MANHASSET HILLS NY 11040 Property Address 1 5705 STILLWATER ROAD City St Zip CUTCHOGUE NY 11935 Tax Map No. section 137.00 block 4 lot 4.000 Cross Street STILLWATER ROAD Building Permit Number Cross Reference: Issue Date: 10/27/09 Elizabeth TA. Neville Southold Town Clerk (TOWN SEAL) it /,Ia,�O�OF SO(/ryOl ELIZABETH A.NEVILLE,RMC,CMC s i O Town Hall, 53095 Main Road TOWN CLERK �14, P.O. Box 1179 REGISTRAR OF VITAL STATISTICS v' ,e Southold,New York 11971 MARRIAGE OFFICER : COQ�1�, Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ,• Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER =ireOUNTY,* �� , southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TECEOWEI TO: Southold Town Building Department OCT 2 6 2009 1-11 FROM: Carol Hydell, Southold Town Clerk's Office BLDG.DEPT. DATED: September 14, 2009 TOWN OF SOUTHOLD Transmitted herewith is a copy of application No. 3900 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Peconic Cesspool for D Gerowski 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. * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: Maintain required setbacks from adjacent wells, buildings, property lines and water Bodies. EXCAVATION INSPECTION REQUIRED. i%Z/7:;:Signature /c972-- 7 Dated ELIZABETH A.NEVILLE i'�'ZG'y Town Hall,53095 Main Road TOWN CLERK ' o ; P.O.Box 1179 ti a Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ` rr► i� MARRIAGE OFFICER ` G `F 1� Fax(631) 765-6145 '%' ' ' Q.oft Telephone(631) 765-1800 RECORDS MANAGEMENT OFFICER :,�e40,00 FREEDOM OF INFORMATION OFFICER =.'t �� southoldtown.northfork.net OFFICE OF THE TOWN CLERK • TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT . APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 " or Non-Residential @$25 Application No. Permit No. Applicant Name PECONIC CESSPOOL Applicant Mailing Address p. o. BOX _ 487 LAUREL, NEW YORK 11948 Septic Tank zi or Cesspool X ��'�'`-�� Cess, ���� Brief Description of Proposed Construction or Alteration /7 Location of Proposed ConstruG-OrYk0 ctionn/Alteration- Owner of Property: (/‘)S (1 I. )o Owner Mailing Address: S'el -6roo 14.. C4 . S . I(Yl Ah h a, se_i 14: 11s 11046 Owner Property Address: 705 ,5-h-a J pri 'Rd - • aa-of o �a NY l 19 . 5`� Name and phone number of contact person I Lefentki 5-1.2, `>g9 s, Tax Map No: Section 13-7 Block Li Lot L1 Cross Street 50 6_© / —c24° S q-DaG461 e("al NOTE: LOCATION MAP MUST BE SUB a ITTED WITH 'PLICATION. NEW CONSTRUCTION REQUIRES SURVEY WI.' HEALTH DEP• NT APPROVAL ) # ° 1 likt •4 "Applicant Date Received by: N t (1/10j11),4 4-f-e,e4--- (t; ir\eio. - ( , (-1 61: f ( o ...... '47 _