HomeMy WebLinkAboutShaw, James SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3463 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : STANLEY F. SKREZEC
Address 1: 50 GULL POND LANE
City St Zip GREENPORT NY 11944
Descripton of Proposed Construction or Alteration
-CHANGE INSIDE PLUMBING FROM WEST TO SOUTH SIDE. FILL IN OLD GREASE
TRAP-USE EXISTING CESSPOOL FOR GREASE TRAP, ADD A PRECAST CESSPOOL.
-MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY
LINES, AND WATER BODIES. *EXCAVATION INSPECTION REUIRED*
Name Of Owner JAMES SHAW
Mailing Address 1 11 MIDDLETON ROAD
City St Zip GREENPORT NY 11944
Property Address 1 530 MIDDLETON ROAD
City St Zip GREENPORT NY 11944
Tax Map No. section 40.00 block 50 lot 4.000
Cross Street C.R. 48
Building Permit Number Cross Reference:
Issue Date: 9/18/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
leg/ '--�
•
011 �pF SOUry-
ELIZABETH A. NEVILLE ,`off 0
l0 Town Hall, 53095 Main Road
TOWN CLERK * 4; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS N Southold, New York 11971
MARRIAGE OFFICER �1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER � ���, A-• •
Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �'QU ��`(,'`�d �southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
i,.. TOWN OF SOUTHOLD
.- Southold Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
DATED: July 31, 2006
Transmitted herewith is a copy of application No. 3617 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Stanley Skrezec for James Shaw
Please review the application and location map and advise if the project has received Suffolk County
wealth Department approval and if this office may issue the permit.
mase ,-;ompiete the form below and return it to me.
Linda J. Cooper
:;ave reviewed the application and location map of the project cited above and make the following
r ecommendations:
APPROVE
DISAPPROVE
.Thmments: Maintain required setbacks from adjacent wells, buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED. •
71'4 q,
signature
0 b/,.2-/o 6
Dated
OFFICE OF THE TOWN CLERK ''''' ' ' ' 6/7
/ ``�
Town of Southold ''"i �FFDIK1 i�j( /
10� % Q/ , Application No.
Judith T. Terry, Town Clerk ; �, y�
Town Hall, 53095 Main Road Z ; Construction
P. O. Box 1179 z
o ^` ; Alteration C/
Southold, New York 11971 �� / -
Telephone t.
0 ��ot' $10.00 - Residential L/
(516) 765-1801 - 1
01 i,$' .' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit N.:( 1)1
Fee $
DATE SUk2_ Iyf 'Let,
APPLICANT NAME: S,l .;' JFs, (41rel.A.,c
APPLICANT ADDRESS: St„ Com; LL c:,V^-�� -t'
C-- r-�4?:1 y-r 4; • kj L ( y 4
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION CtC6'
L. cy,te4e_--ciaip� -Li 5¢_ ex.i Fski Cess c ?c- E' G.r_amwe, df 1.
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ,, trvwe % S ‘4141-‘4 _
OWNER MAILING ADDRESS: l V.h.6n (.e ., (ZO
69V'ee"gork- tly . Y• ( \cit
OWNER PROPERTY ADDRESS: `S- . 1Z) v"- 4 p k i-e.„ 12 0
cwt-, IQ, v- <\' 49
TELEPHONE NUMBER OF CONTACT PERSON: 417 - lk' Z 2-
_ O r
TAX MAP NO. : Section -03'04z7 Block -5 Lot 4
CROSS STREET: �1cC.' 1 p
BUILDING PERMIT NUMBER CROSS REFERENCE: 317-`1
dir*a • F iltec.,
Signatu e of ' pplica
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RECEIVED B #1
Town Clerk's Office
DATE: >� I
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