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HomeMy WebLinkAboutCichanowicz, David • ,/ S�fFO(,�co ,4 0O G JUDITH T.TERRY tt� = y1• Town Hall, 53095 Main Road TOWN CLERK ; y 2 $ P.O. Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS O MARRIAGE OFFICER yijJ ��of Fax(516) 765-1823 V RECORDS MANAGEMENT OFFICER Ol **.-01 Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER � OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1411 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : DAVID CICHANOWICZ Address 1 : P. O. BOX 160 City St Zip PECONIC NY 11958 Descripton of Proposed Construction or Alteration SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. SCHD REF. #R10-95-0115 Name Of Owner CICHANOWICZ, DAVID Mailing Address 1 P. O. BOX 160 City St Zip PECONIC NY 11958 Property Address 1 ARSHAMOMAQUE AVENUE City St Zip SOUTHOLD NY 11971 Tax Map No. section 66.00 block 3 lot 16.000 Cross Street MAIN ROAD Building Permit Number Cross Reference: Issue Date: 11/14/95 Judith T. Terry Southold Town Clerk (TOWN SEAL) / ' /7 ,,• 0° \>,gtFFow O(�60 1 # may ; JUDITH T.TERRY �� = Town Hall,53095 Main Road TOWN CLERK y Z % P.O.Box 1179 REGISTRAR OF VITAL STATISTICS O 'W 0 Southold,New York 11971 MARRIAGE OFFICER =W Q�� Telephone(516)765-1800 ,�� Fax(516)765-1823 RECORDS MANAGEMENT OFFICER i O .! lig ,1 FREEDOM OF INFORMATION OFFICER v„„ ,4,01' \\ . OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD `Y, 4/ '. `/ TO: Southold Town Building Department -.(', ?/9 FROM: Linda J. Cooper, Southold Town Clerk's Office 9S DATED: November 2, 1995 Transmitted herewith is a copy of application No. 1464 for a Cesspool/ Septic Tank Construction Permit submitted by: David Cichanowicz 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, I fy Thank you. NinV — 2 !Q• 4.,, ,_.,,, Linda J. Cooper * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE e'. DISAPPROVE Comments: or .,ey,,, 6 7 421/ /0 —9r— O//5' ,..... .-/Wvencf.)- , 7,47 Signature /7 /V/i---- Dated w OFFICE OF THE TOWN CLERK •,,���0lx,. ..,,,•.,, Town of Southold •'�I, �'�G Application No. /y6,f Judith T. Terry, Town Clerk / Town Hall, 5305 Main Road �•• s`' "`° c_-- _ Construction P. 0. Box 1179 • Southold, New York 11971 • tt) �•' Alteration • ‘‘V'' $10.00�C' •' - Residential Telephone . •• (516) 765-1801 1 * ,, ' $25.00 - Non-Residential • . • I, TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ DATE 7•16V I J 199,r 99,ti APPLICANT NAME: '111,6/t CjC. /-E-A/VOW/C2 APPLICANT ADDRESS: .j 2 ( 6.7 ! �lO °g_C.©6..I t C _ 1 C Sj — SEPTIC CESSPOOL 0'1- DESCRIPTION DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION ' Carus,2v� tJ I •' i Cb111j et.(--( •u, LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION : OWNER OF PROPERTY: ‘-1)14tAN � ostll -Z • OWNER MAILING ADDRESS: `? �d s OWNER PROPERTY ADDRESS: ft-e- 14A-too motiaor--- Ate so ..ft-tto\sra, TELEPHONE NUMBER OF CONTACT PERSON: 74__ '7 92 . 7D TAX MAP NO. : Section o cO Block Lot (l" CROSS STREET: BUILDING PERMIT NUMBER CROSS REFERENCE: Iffe Signature of i• pplic-astri RECEIVED BY: Os- Tc3wn / Clerk's Office DATE: C - /pd-- r _i SUFFOLK CO.HEALTH DEPT.APPROVAL ! J1 = i I H.S. NO. Ii I ! if t fes` �(uE - ` 1)) i I Cf?5POOLS 7---.-_ r-' `( • ..i\ I \ 2 STORY 1 i . 11 FSZ.HOS` SEPTICTAtu. I GAR. ,4- -__: STATEMENT OF INTENT $� -Peck. I I THE WATER SUPPLY AND SEWAGE DISPOSAL 11 ti ie ""-� \1 \� ..1 ,� SYSTEMS FOR THIS RESIDENCE WILL `I ,i \ z I CONFORM TO THE STANDARDS OF THEM ' N.T3 0C . / I Zr-1.0 , ‘ �c SUFF• K DE` O A , SERVICES. Cr, Z - f3-- ITS. ----1-------113 Ts e3 a, << f �, ----- .; --- 3 m ISI '7�"i"• t --1---! : ! ^i --t APPLICANT Ai Q3 \ >, it .GAR. 1P P SUFFOLK COUNTY DEPT. OF HEALTH ,, \ fa: LR1VEiOPE.OF MOP.I"10., h ®-E. ` t.1\-- , ��1� \�� 'S, �• gt GECK SVI/MMn�lC;POOL I`✓ % ZZZ al \ SERVICES - FOR APPROVAL FOR �' L'C' `1 \ ,(L °� J__ in j CONSTRUCTION ONLY C�, �. • � to0'.. -Ley;, - > rDATE: }in OCT 13 1995 Q'! • r E5 Z � �_ ; H.S.R •. • . `D i 4 u. - 3 a��O7�ir 0,plc. �� P. DR►VF��1 , f t r r , > is `3 G' N/E- 1 APP-.• `.' —" �.i-i b di +A \Z •cp ACM--- i t 15 p if1 R1 + �/� 1 IR. t 9 f. op-um;refi.,,,_LUNE-, . 4p_� , 1 ' �_ ed.- - , T `_m �' T ! 1p JJ t P SUFFOLK CO.TAX MAP DESIG ATION: 1.9 i -cC, ?3 00 W ► \ 250.0 ✓ I ° I • �•00� 1. \ I. \ \ ' { DIST. SECT. BLOCK PCL. \ 1000 66 3 16 �°'� F i--- FL0OC 3JIJES;- ''G ---..\ �-D--. ....-- OWNERS(EL — - �Qo • \ OWNERS ADDRESS: '4 .00 �tr.:21 � ii9 �' \it\ � > ttcLT.tvE_ET1VItZQNMENTAL2 tS GtsS C VtCJ NT� Y I MAi1.J 1ZU^D k / J ciiigPEcoNic,N.Y, I1958/ 22,.0 0 TEt::T34-7923. MAFOF 2OPE2T'e" p DEED: L. P. j./` ) TEST HOLE S trZVEY.EQ For- *-i ! romw wmy r avlolatea.. }j F�'�{ J��'} tt\j� /!i{ 7 �_-- _ I Section 7208 of Ne Now Welt Sego II 1 FR,'1110. n ! !MOWN Copes of MiswMymao not eoatfafl `T _--'--- fi % lore rand wwe eon not sec or !l '� 1n111t1 mnxsec.w.nsu mt w considered _ '—"S�'—' ��: I' nmeva(ie tme coW. S 1 Moon Sae((run I ceommocs ilea . IZS!4RMOMAQJE PLEASE NOTE i nny(n he person fm Wem the wmoY T r Ste' to .x as Y 4- fa tMwd / ..OF, SQUT!-�0�3 KIN( �✓�LE4v`! j ; BROWN i Mprepared,s ieo Y !/ 0•MON J 4ENT i I TY LOA limes`'"y�os listed esfeOn.w SI M rneno 1.1 It is the applicant'a--r ©nsibility-tc-.-- . - -.. __—. •PiaE ; 1hme i maintain adequate sanitary distz rr ! / I _. �.ers. aEA=19,7>b3sc•Fr. I I� I between all water supply and s.,....-•-• t.- - I ' disposal facilities. ��x�`I" j ? SEAL KKITES: 1.LOT NO'S.REFE2 10$LOGIA Z ON MAP OP rEiXE✓ON EST S, AMEt JOEL ..JJN6 : Icy c �nDn t I PALE 82ovJN� C FI Nth; - - ,_ = L _72_T1-:le /JNErc l�{C f.'7 FINE TO 'a FILED IN HE`SOFF, �.CLERKS OFFICE A.S. �;,Nc t,,,,.',. '2• ALIG � 1995 NATIONS TITLE1N51 E Ca.OFNY{ COARSESVdL' t Cy� j 2.COI'JTOJ�'t5 2EFEG. TO MEAts4 SEA LEVEL,N.G.V.a, SEPT fa,1995 A SURVEYED NOv_22.199ri i 16�1* ROQER'-,S VAN YL. C. I e t F120N SJFF. c.o.. ,4Ef:'1,� ` .'2VE`!. rG I � 0 2561 Q• • SUFF.CO. TAX MAP NO.: 100 6� '5-lip. ?aND 5,,. LICENSED LAND SURVEYORS I 17 I ,ys • GREENPORT NEW YORK I f j IC oY.et roar Maur I