HomeMy WebLinkAboutCieplinski, Frank ire
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JUDITH T. TERRY � Z G : Town Hall, 53095 Main Road
TOWN CLERK :
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JUDIT T. ` ' ` DEPT. •
'�OF SOUTHOLD % ` Town Hall, 53095 Main Road
TOWN CLERK Z i P.O. Box 1 179
REGISTRAR •OF VITAL STATISTICS cm 'T , Southold, New York 11971
MARRIAGE OFFICER . W 1 Fax (516) 765-1823
V. ��'��� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
July 17, 1991
To: Southold Town Code Enforcement Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. 760 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Windsway Bldg. Corp. for Frank & Barbara Cieplinski .
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 -
COMMENTS: p,. .A.......egi.,t,c1► LL 1 1111.1 CAl.My\ q c ..9.1
041,,,,,,...1,,\,,,,cz..\,...A %AI ' ....k.))„2)G (4) . k.,..0i,.. 1
tic.V cam. „......100 41.-k.
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Signature RECENED
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Date JUL 2 6 1901
Town an slew
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OFFICE,OF THE TOWN CLERK - ` ,�
'Town of Southold c��FFUtk�O =_ Application No. �c�r.*
Judith T. Terry, Town Clerk Gy
Town Hall, 53095 Main Road Construction
P. O. Box 1179 : =i n=+ ; Alteration
Southold, New York 11971 ;� �;
Telephone �O,j► Q��i. $10.00 - Residential
(516) 765-1801 =y�1 �,�� $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. Ila e
Fee $ /0
DATE a///)/q/
APPLICANT NAME: j k f Z j„(6' , ; 47,
APPLICANT ADDRESS: /6.)--41 .�i/a,v Al_ fdry /<C-2l
SEPTIC /CESSPOOL 1--
DESCRIPTION
DESCRIPTION OF PROPOS D CONSTRUCTION OR ALTERATION
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,,,,,,,,______,4„ ,i,.. ,....„7,__
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
• OWNER OF PROPERTY: A4.44.< g Awa (2/g,/dtiorc/
OWNER MAILING ADDRESS: crpt,�jj ,✓✓� (,I,�1�,.✓!:‘,
1
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 74-j-:--/3.1(C---
TAX MAP NO. : Section 6-ti Block 3 Lot r11a cL
CROSS STREET: e /o/y29 zg4 A1 i
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
Signature of ' pplicant
RECEIVED BY:
Town Clerk's O ice
DATE: -7 — / 7 c(f
h
NQtL SUFFOLK CO.HEALTH DEPT.APPROVAL
1. 17111CM ' E_ iNC:L:' E".: 1'?1.1c'Tr QFL,_Jl 5 i,,40 {1h
i,,40 p!,4' /F" —)Q- '/7 H.S. NO.
CEC1Ac_.L AC.I-4 ;-1,A: 6C•',FIL.EC> IN-T14 �UFH,CO.CLE21 ,: a
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OF'F'ICE, MAL' f.+J 9J F4
2 0h1TJUIZS 12L'F-Ef� 70 MEa.hIrCA t_El'e=L,
sesiperqck:\ \ —_- (VACANT) ---.-- -- o
a3 _ WI STATEMENT OF INTENT
_—fit—`_
rwEY / I i Q/ V THE WATER SUPPLY AND SEWAGE DISPOSAL
L J� SYSTEMS FORRESIDENCE WILL
vFr k:-.' ci,J `�04.r .E __ -_ p tYr I `i o/, ay J1 `� 1 CONFORM OTHIS ANDA S OF THE
f .iK v r c- SUFFOLK PE' ICES.
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a 180 - �+ j t,= Qp APPLICANT tK.tl7
y SUFFOLK COUNTY DEPT. OF HEALTH
/ , f.-- f —ro.)-- - J / £ -> SERVICES - FOR APPROVAL OF
L h ` ',= C.E.-: wETLAN(i1. u CONSTRUCTION ONLY _
P-,' N ni ..\ I -� <vAcal�i i
'.ti rP �PCOI-. + 1�� LINE:: �< L O i`l DATE. /-( 6 L I
Ni Z •i NG. 1 �_ • H.S.REF.NO. ) ' .
• �_ CA•�y • p, gyp' a, Q4n_I-;tt1; +/ 2 /,` I1 � APPROVED __ =`, -. .
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455 _ SUFFOLK CO.TAX MAP DE IGNATION
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ti�4, N.>✓GG �LJ�W. , 4c..-dr....i.:J .).4. 111 .:!. DIST. SECT BLOCK PCL.
' 4.-A� • } r� p' I Ll OWNERS ADDRESS:
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- DEED: L. P
E 'x�s ..'1'Ec5T HOSE — TEST HOLE STAMP
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SINGLE FAMILY DWELLING ONLY--- ! ttowri
�•, �� EXPIRES TWO Yk.t�fi. FROM! DATE OF VAL WELL COVENANT REQUIRED _LOA.M ."s "�
4 PRIOR TO FINAL APPROVAL. t tl
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JUN 28 1991 _____ - --- _-_..___.___..-____ \ (I \ �_
\ Rpa. if . VAN L.P.0
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S.C. 'OF E'al�Ul E\f PCT. ,,9BfS
/ JUNG Ex, 1991 LICENSED LAND SURVEYORS
HEALTH SERVICES . -- -- --- GREENPORT NEW YORK W U ,I 'Ve Al 1
::wN . r�F ..�UUi i-IOL U N.Y.