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HomeMy WebLinkAboutCherepowich, Joseph NO z d Town Hall 53095 Main Road 'At, P.O. Box 1179 `;};( ' `f+` Southold, New York 11971 JUDITH T.TERRY TELEPHONE TOWN CLI RI.. (516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD October 15, 1986 Long Creek Homes Inc. Main Road Box 439 Jamesport, New YOrk 11947 Re: Joseph Cherepowich Main Road East Marion, New York Enclosed herewith is the Construction, Alteration or Modification Permit for a Septic Tank or Cesspool System for which you applied. Please be advised that each owner of real property operating an on-site sewage disposal system, such as a septic tank or cesspool must, prior to such operation, possess in the name of the owner an Operation Permit for the system. The Operation Permit is issued by the Town Clerk's Office. The fee for an Operation Permit is ten dollars ($10.00) for residential use and twenty-five dollars ($25.00) for non-residential. Please have the owner complete the enclosed Application for an Operation Permit and return it to this office along with the proper fee. For your general information I have enclosed an Informational Bulletin regarding the Scavenger Waste Laws adopted by the Southold Town Board. Should you have any questions pertaining to either permits or the Scavenger Waste Laws, please do not hesitate to contact this office. We will be glad to assist you in any way possible. Very truly yours, gl lerm•It 4 Vegodli . _ U Judith T. Terry Southold Town Clerk Enclosures (3) JTT/Ijc OFFICE OF THE TOWN CLERK c\\VFO(/re," Town of Southold DSO OGy Judith T. Terry, Town Clerk Town Hall, 53095 Main Road - P. 0. Box 1179 Southold, New York 11971 Telephone X01 „ (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 59 Residential XX Non-Residential Fee $ 10.00 Septic Cesspool XX PERMIT ISSUED TO: NAME: Long Creek Homes Inc. ADDRESS: Main Road, Box 439 Jamesport, New York 11947 DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION New One Family Residence LOCATION OF PROPOSED CONSTRUCTION or ALTERATION: OWNER OF PROPERTY: JOseph Cherepowich OWNER MAILING ADDRESS: Gillette Drive East Marion, New York 11939 OWNER PROPERTY ADDRESS: Main Road East Marion, New York TAX MAP NO. : Section 38 Block 1 Lot 1 .1 CROSS STREET: Gillette Drive BUILDING PERMIT NUMBER CROSS REFERENCE: Pending Judith T. Terr Southold Town Clerk DATE: October 15, 1986 (TOWN SEAL) 1111 <f, • 1986 r77 p ' Town Hall, 53095 Main Road -'.'.. _4.0/ • P.O. Box 728 • Southold, New York 11971 • JUDITH T.TERRY TELEPHONE TowN CLI RK (516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD October 3, 1986 To: Victor Lessard, Southold Town Building Department From: Judith T. Terry, Southold Town Clerk Transmitted herewith is a copy of application No. 58 for a CONSTRUCTION or ALTERATION Permit for a cesspool or septic system -.,. submitted by Long Creek Homes Inc. for Joe Cherepowich • Please review the application and location map and advise if the project has received Suffolk County Health Department approval and if we may issue the permit. Please complete the form below and return it to my office. Thank you. Judith T. Terry Southold Town Clerk • I have reviewed the application and location map of the project cited above and make the following recommendation: APPROVE - DISAPPROVE - COMMENTS: Signature Date OFFICE OF THE TOWN CLERK Town of Southold Judith. T. Terry, Town Clerk Application No. Town Hall, 53095 Main Road Construction P. O. Box 1179 Alteration Southold, New York 11971 Telephone Residential (516) 765-1801 Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL C7 Permit No. �� Fee $ DATE /6'/3/(r APPLICANT NAME: ,••`•:� -r�� • o /vG .Q _ - -._- ��-!�' APPLICANT ADDRESS: n � i.L Q.i5 _ (30-ze Cf 3c( s PvAL-z N-y . // Y7 SEPTIC /CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION v/s. /i4 f^I i "K LOCATION MAP: Must he attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: N.S c) G E-E a {Ja 1,telG64. OWNER MAILING ADDRESS: LL47E i> 2 ,E,v 57 /7 p-!2- N ,/.L/- s/s OWNER PROPERTY ADDRESS: /l-1<<y ,4() - Lr-/.4 <-7- /1,y ,Q�G/-', /0a / 1F •/z_z_s t 1sk— TELEPHONE NUMBER OF CONTACT PERSON: Z.2...2- ///'g/ TAX MAP NO. : Section O 3 p Block / Lot /,/(/p,,i CROSS STREET: L L 1 E P e BUILDING PERMIT NUMBER CROSS REFERENCE: Signature of Ap scant RECEIVED BY Ara .1 Town C rk's Of ce 1 l6� io' Ywaw tl a�®4iILflidhYIW YIa1Y�PP PIrIYn YJ i,I1YIYiP4WWrW _..Y �I Ilk, ..JYa I��I��i�uha�M! •P.J + �n ��� �y �„,�J;I IIS nlml•�..i.Jii, u.l. Illu .L .i.i.lY.l.._..l.;. li�__ iii i Id, i i. _ ._, �i i ii.I. ._ �.i....-. � l .- .. . ... ... .. , _.. ..I... III r._ . ._.._ __- -___—__. _.__.___..__.__ _ 1' SUFFOLK CO HEALTH DEPT. APPROVAL � 1 H S NO mr ,?. r :;., n,i SINGLE '_ 0 / 0 Y A S1LY DW FROM UAE U� Art-i-,,..;r a 5Z 5a;,E. _ �f EXPIRES TWO i _ — _---- – p I STATEMENT OF INTENT i Q THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL i `t ! i CONFORM TO THE ST •4 raARDS OF THE - . Q Q. .' . SUFFO O DEP . v EALTJHH�7SER VI S. G 01 . co '11 -' (s) - C� 4)Lf��^c; c; • . ts Q r_ �,. I T' 1/ P OP IF. OPEYAJ/APPC i�1 h a SUFFOLK COUNTY DEPT OF HEALTH j • h A �.. SUA2VEVED b Ok SERVICES FOR APPROVAL OF t4 f, ``r d / _ PH �^, /�v �-'�}/� 1 ` CONSTRUCTION UN�i tri ! (T3 +�' b+� �.J o 5E Cl-/ )C L-..t"o 1!1 r t.,,.•1--1 DATE J P 3 O 98 6 roe.1 i- ar'Glecr,. .� _ _ .f 0te `” .4T H. S. REF. NO A. -. T`�fi` APPROVED: 414g1 .... ._ a o tki �;�,,�eaor BAST' 11/lA�r0N q \ �� i SUFFOLK CO. TAX MAP DE NATION: :�. tai � � 1 �+�,�J i•c5°X.j p J ls 1 (. .1ti DIST. SECT BLOCK PCL. 4, `� --- + --t_ & felW ;500 U 38 . 1 1./4:h4Cr) OWNERS ADDRESS: Ci r� dd,6f C � /a f� vv G•+/L 1.<" '�J-if:: .Uig:ir`t' 4 ::- 0 I �� /Q 1 A 5 i• !►'/A it.._/0/1.11 i. ,, i f 1 '1 9 'r '., i 3 s- Icy /. y . C• f_ � N 7-Ci.. 477-0986 Is 1 o / `� ;c,(1�c:�r,, i'�rti .1►� Co. �`c�f�c rrrc,�,5 . • DEED: L. P. I --r TEST HOLE STAMP L, 1 ' i /,. 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