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JUDITH T. TERRY . Z ` ; Town Hall, 53095 Main Road
TOWN CLERK : p rZ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �V6Fax�'y0 *w ��•�� Tel phone(516)57651801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 844 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : WINDS WAY BUILDING CORP.
Address 1 : 1020 GLEN ROAD
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH SANITARY SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 5/14/92.
Name Of Owner CICHANOWICZ, FRANK III
Mailing Address 1 LUPEN DRIVE
City St Zip CUTCHOGUE NY 11935
Property Address 1 INDIAN NECK LANE
City St Zip PECONIC NY 11958
Tax Map No. section 86.00 block 4 lot 6.000
Cross Street LESLIE ROAD
Building Permit Number Cross Reference:
Issue Date: 5/28/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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9' i' MAY 181992 ,o'''. "1-irt.G__
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JUDITH T. ,y a, (. • ' _ :, yL Town Hall, 53095 Main Road
TOWN C .RK TOWN Gf .:` : o T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � ` Cr ' �` Southold, New York 11971
MARRIAGE OFFICER yO/r�O �_`O�r���, 3
TelephoneFax l6)(516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Southold Town Code Enforcement Officer
From: Linda Cooper, Southold Town Clerk's Office
Dated: May 18, 1992
Transmitted herewith is a copy of application No. 866 for a Cesspool/
Septic Tank Construction Permit submitted by:
Winds Way Building Corp. for FRANK CICHANOWICZ III .
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.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
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APPROVE i,9y 4
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DISAPPROVEgip A?
Comments: nn Q
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ctler-lustS 91 t.e.Ai A_ oNn Sj i kji 4 1.._
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Signature
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Dated
OFFICE OF-THE TOWN CLERK ,,'"""''•-
Town of Southold .'"Of
Judith T. Terry, Town Clerk � Application No. g4��
Town Hall, 53095 Main Road Z < Construction
P. O. Box 1179 c mm,
Southold, New York 11971 Alteration
Telephone �°,j�o �P0�' $10.00 - Residential
(516) 765-1801 _ 1olt
,,,,,, $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ DATE 4/77
APPLICANT NAME: 4Z a Laid UU/:c-L. 4(40 4I "i
APPLICANT ADDRESS: 64-epeit/ P` •,/4 Al( )
0)-0 its),
SEPTIC VCESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
•
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: -#h CrC. "Ai el ae
OWNER MAILING ADDRESS: G 4r� h,, •, " C 1-(7a/ /1 5' ,
OWNER PROPERTY ADDRESS: /k/r `J' 6t4-40 4 / ; y
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TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 1916 Block y Lot /9/o 4 •
CROSS STREET: /yr-di`c-
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY: •
�o n Clerk's Office •
DATE: -- 5 t �' �
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SUFFOLK CO.HEALTH DEPT.APPROVAL
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