HomeMy WebLinkAboutWysocki, Edward (2) SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3462 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : EDWARD J. WYSOCKI
Address 1: 37455 MAIN ROAD
City St Zip ORIENT NY 11957
Descripton of Proposed Construction or Alteration
-NEW HOUSE
-FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT
Name Of Owner EDWARD J. WYSOCKI
Mailing Address 1 37455 MAIN ROAD
City St Zip ORIENT NY 11957
Property Address 1 SAME AS ABOVE
City St Zip 0000
Tax Map No. section 2.00 block 10 lot 3.800
Cross Street
Building Permit Number Cross Reference:
Issue Date: 9/18/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
�•�• �..
#%pF SOUly &;)O
ELIZABETH A. NEVILLE ,O l0 Town Hall, 53095 Main Road
TOWN CLERK *; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
Southold, New York 11971
MARRIAGE OFFICER Gjt Fax Fax (631) 765-6145
its
RECORDS MANAGEMENT OFFICER 0 I�1 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `.h7 d,(
0 u Woo southoldtown.northfork.net
:OFFICE OF THE TOWN CLERK
JUL I 7 2 "S TOWN OF SOUTHOLD
•TO - Southold Towilding Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 3615 for a Cesspool/Septic Tank Construction or
Alteration Permit submitted by:
Edward Wysocki
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: / -C
Signature /
D 7 si o�
Dated
Or0" %uFFOL4
ELIZABETH A.NEVILLE - •I `Z` OG
�r ; Town Hall, 53095 Main Road
TOWN CLERK . , P.O. Box 1179
REGISTRAR,OF V[TAL STATISTICS
j Southold, New York 11971
MARRIAGE OFFICER 47$l� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ;y ��rrr Telephone(631)765-1800
FREEDOM OF INFORMATION OFFICER -_ el 4 �'�tor 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 Applica '•r},No. ! 1 (76
Permit q
Applicant Name // it/IV2d --J r ofi OO ,.
Applicant Mailing Address ._.32c5--,5',/zj / .
C:6 i
Septic Tank_ or Cesspoo
Brief Description of Proposed Construction or Alteration i!✓ ,-vis
Location of Proposed Construction/Alteration:
Owner of Property: ••••=06.0;41-6.3 4 4 /y fC_JC 4 `
Owner Mailing Address: . / I
t,y //C"f---7
Owner Property Address: ,q
Name and phone number of contact person
Tax Map No: Sectione2— /3a1ock Lot
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEYALTH D ' _ 'TME NT APPROVAL
_ r"--- i_OQ
Signature ' •• an D
Received by:
•
SURvY OF fi'ROiER-NuFFOLR.COUNTY DEPARTMENT OF HEALTH SERVICES
SITUATE: ORIENT PERMIT F011 APPROVAL ..DEPARTMENT
FC411 A N
TOINNI SOUTHOLD 6-IN LE FAMILY a'; :"s ICNCE ONLY
SUFFOLK COUNTY NY �I�
DATE 0U ,, I S
SURVEYED OI-21-9q /r
�_ � r� -. W+
E
SET CORNERS 01-20-04
FOR 14 BEM* f
PROPOSED 12-02-03' APPRO D ��
REVISED 02-21-05 ` �' L S
SUFFOLK COUNTY TAX # EXPIRES THREE YEARS FROM DATE OF APPROVAL
1000-20-1-3.8
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