HomeMy WebLinkAboutCichanowicz, Frank III (2) .00c)qf OLA-
- JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK : P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .�► ,� Southold, New York 11971
MARRIAGE OFFICER i �- ,� Fax (516) 765-1823
�1��00.. Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 823 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : FRANK CICHANOWICZ III
Address 1 : P. O. BOX 222
City St Zip PECONIC NY 11958
Descripton of Proposed Construction or Alteration
REPLACECOLLASPED CESSPOOL THAT WAS APPROVED BY THE SCHD IN 1986.
APPROVED AS SUBMITTED. HOLD 12'0" SEPARATION. EXCAVATION INSPECTION
REQUIRED. CALL SOUTHOLD TOWN BUILDING DEPARTMENT (765-1802) FOR AN
APPOINTMENT.
Name Of Owner CICHANOWICZ, FRANK III
Mailing Address 1 P. O. BOX 222
City St Zip PECONIC NY 11958
Property Address 1 MAIN ROAD
City St Zip PECONIC NY 11958
Tax Map No. section 103.00 block 1 lot 19.001
Cross Street HARBOR LANE
Building Permit Number Cross Reference:
Issue Date: 4/28/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
CCC��/
.00 C�c0 1 O1.K =
JUDITH T. TERRY Z .G Town Hall, 53095 Main Road
TOWN CLERK t p rZ P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS .VS Southold, New York 11971
MARRIAGE OFFICER ‘'‘V44. �- ��, Fax (516) 765-1823
=_.�O ��0 ,� Telephone (516) 765-1801
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rOFFICE OF THE TOWN CLERK
A 2 (992 TOWN OF SOUTHOLD
To: Southold Town Code Enforcement Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A849 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
FRANK CICHANOWICZ III •
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - K
DISAPPROVE - n
COMMENTS: "'to , . .QQl Q.,0-0 air j 1 CQ,cs.o ZL.CL.1
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.k. ‘� Signature
0111‘ •\46.% .Z— L, cl, Z Date
OFFICE OF THE TOWN CLERK
Town of Southold i ^O� Application No. �(/ 71
-Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Construction
P. O. Box 1179 ` y
Southold, New York 11971 Alteration
Telephone fool z e N'6_,,(0' Residential
(516) 765-1801 "� Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION ALTERATION PERI
SEPTIC TANK �SSPO��
Permit No.
Fee $
DATE 'r� l zv t 1C07.—
APPLICANT
a0ZAPPLICANT NAME: (Ycvt_. C; u c ,
APPLICANT ADDRESS: RA- ZS R
SEPTIC CESSPOOL y
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION T`Y ,c
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sf p.�� IV's dot s'�, -c'S-15
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Q
OWNER MAILING ADDRESS: PQ 30-9. zZZ
1115 9
OWNER PROPERTY ADDRESS: -717ce_e_A
TELEPHONE NUMBER OF CONTACT PERSON: �vcAC
� .n Z G.q vt J w (--S I 1
TAX MAP /NSd? Section 1 03 Block / Lot 19. 1 •
_ CROSS STREET: Po ZS- �f
BUILDING PERMIT NUMBER CROSS REFERENCE:. Mew
At_ C-e/
Signature of tplic
RECEIVED BY : 1
CCA-1-1----
,T• in Clerk's Office
DATE: 4 4
APR21. 199
tcvm Cot 934/161
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