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Home My WebLink AboutCichanowicz, David (2) .--T-01--- z _ c,UFFG'j-C '` J it, rV•kt�' c : ; Town Hall, 53095 Main Road % P.O. Box 728 Southold, New York 11971 JUDITH T.TERRY TELEPHONE TOWN CLERK (516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD October 3, 1986 David Cichanowicz 165 Wood Lane Peconic, New York, 11958 Re: Miami Avenue Peconic, 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, .....00'. 4....40411)11;14.... Judith T. Terry Southold Town Clerk Enclosures (3) JTT/Ijc OFFICE OF THE TOWN CLERK cOFNI' Town of Southold Judith T. Terry, Town Clerk Town Hall, 53095 Main Road P. O. Box 1179 � Southold, New York 11971 O _•:;r• Telephone Ol t ' (516) 765-1801 .777 ' TOWN OF SOUTHOLD SOUTHOLD WASTEWATIER DISPOSAL DISTRICT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 49 Residential XX Non-Residential Fee $ 10.00 Septic Cesspool xx PERMIT ISSUED TO: NAME: David Cichanowicz ADDRESS: 165 Wood Lane _ Peconic. New York 11958_ DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION Construction of a One Family Dwelling LOCATION OF PROPOSED CONSTRUCTION or ALTERATION: OWNER OF PROPERTY: David Cichanowicz OWNER MAILING ADDRESS: 165 Wood Lane Peconic, New York 11958 OWNER PROPERTY ADDRESS : 50 Miami Avenue Peconic, New York TAX MAP NO. : Section 67 Block 7 Lot 3 CROSS STREET: Mill Road BUILDING PERMIT NUMBER CROSS REFERENCE: Pending r 40004 44:0 Judith T. Terr Southold Town Clerk DATE: October 3, 1986 (TOWN SEAL) 0 • 'fp f -7-7'. Lce•-\- rg rick r FR---N. 1 SEP 2 ti i �� ': 91986 �. tJ3 ", t " :LI TCt1'�hr CIF SOUTH'LD Id i �� C: t/ Town a , e v� t. ` P.O. Box 728 "An..'�- 0 Southold, New York 11971 JUDITH T.TERRY TELEPHONE TOWN CLERK (516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD September. 29, 1986 To: Victor Lessard, Southold Town Building Department From: Judith T. Terry, Southold Town Clerk Transmitted herewith is a copy of application No. 4g for a CONSTRUCTION or ALTERATION Permit for a cesspool or septic system submitted by David Cichanowiez • 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. eir,...40ee..;,a,„.............44.0..........0' __ 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 /74 Judith. T. Terry, Town Clerk Application No. Town Hall, 53095 Main Road Construction P. O. Box 1179 Southold, New York 11971 Alteration Telephone Residential (516) 765-1801 Non-Residential TOWN OF SOUTHOLD PIo41noS VC) u,'Ul 98619 d3S SOUTHOLD WASTEWATER DISPOSAL DISTRICT a3A13D32! APPLICATION RECEIVED for ccp 2 1986 CONSTRUCTION or ALTERATION PERMIT r -;; Southold SEPTIC TANK or CESSPOOL Permit No. / Fee .$ /U DATE $EP1T raz, t9a c ` , APPLICANT NAME: t.8, CL_C,}�ArsdwtC'7_< APPLICANT ADDRESS: l — ( OO Lk.iv C- _ LpNAC 1 \ c-‘s . SEPTIC CESSPOOL -- DESCRIPTION DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION • w s-revs_ (. OC- 1k .`ituA ._ Lt r-J( LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: F u a t Cc_ KI O t.A.) tC.-z OWNER MAILING ADDRESS: i LOOD (.tpi./C C_OrU ‘C. 1- T-)- i . I C`r fie, OWNER PROPERTY ADDRESS: .5-6 I(VU.(A114t Atie . PEcofLU I (=.1Cf, TELEPHONE NUMBER OF CONTACT PERSON:GEk..) 7 gy-6 366 - TAX MAP NO. : Section C7 Block 7 Lot 3 CROSS STREET: f)' ,'Ik P ,A-3 f i/M2l . BUILDING PERMIT NUMBER CROSS REFERENCE: 411 . 90.-----C- Signature of Ap scant RECEIVED BY: ', .K,>„ Town Clerk's Office DATE: jaefoT_m_i Gc1ae,, /�6r-(,, St'l�t�EYED FOR:-D,4 I//D C/C.y.=?/VOGW//CZAZE��T - E4E644T/oN5 reEG.aT4/E v3-,.t.. PLEASE NOTE //o a;,•/�-44. E�,A47-,0.45 FaI,;,94, N 0- ,QOCATED AT >qfC .C� 7--;(//t/ -- c.VTHa .•.epG Ccty 1k-/-3! Ex• a¢.- � LOT• 1% LoT.5' 1 V cant's responsibility to T.P MAP OF BG.4NC / f ti the app .6 eve. Di •vSo•� i�ti�Se uate. sanitary distance SCALE r'= S�` + NS between all water supply and sewage �4•-.c0 G .. 'ii i'3. ,r. elinp1?sa 'facilities. - 3 � y¢t� 0457 /Ooo S•ac. 7 8• .. ' Lo r r .-' o I 5.- so -.7 re;,, + / , I S1 o - \� if �® Geo 4 Se- um.... p+2 ------i `) COC) 1V� . (lel s ( TT— � • o-p�{j �� "-K2,/ Ls-1.Q -7- ,-f— (pet w... I 7‘ 8- A . 44/4 MP- -4 VE. 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