HomeMy WebLinkAboutCymbalsky, Sidney •
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JUDITH T. TERRY Town Hall, 53095 Main Road
• TOWN CLERK T P.O. BOX 1 179
REGISTRAR OF VITAL STATISTICS s $ Southold, New York 11971
MARRIAGE OFFICER 0 �� Fax (516) 765-1823
Ain11D0 rr� Telephone (516) 765-1801
---741 JigOFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1029 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SIDNEY D. CYMBALSKY
Address 1 : 65300 NORTH ROAD
City St Zip GREENPORT NY 11944
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR A NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 7/19/93.
Name Of Owner CYMBALSKY, SIDNEY D.
Mailing Address 1 65300 NORTH ROAD
City St Zip GREENPORT NY 11944
Property Address 1 65300 NORTH ROAD
City St Zip GREENPORT NY 11944
Tax Map No. section 40.00 block 3 lot 10.002
Cross Street QUEEN STREET
Building Permit Number Cross Reference:
Issue Date: 8/03/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY ...c. : Town Hall, 53095 Main Road
TOWN CLERK O T P.O. Box 1179i
REGISTRAR OF VITAL STATISTICS .tl� ,� Southold, New York 11971
MARRIAGE OFFICER %0 O� •�' Fax (516) 765-1823
� 1 �1D 0$ Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD ilif ---...-:S'2r/T-;'**
JUL 2
TO: Southold Town Building Department n Si
FROM: Linda J. Cooper, Southold Town Clerk's Office rO 014/./V6i.:-,
DATED: July 20, 1993
Transmitted herewith is a copy of application No. 1058 for a Cesspool/
Septic Tank Construction Permit submitted by:
Sidney D. Cymbalsky ,
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 re''''''commendations:
APPROVE v
DISAPPROVE
Comments: *7A. Sc!, 7 93--SO-/'/ -7/943
RPM
AUG 2 1993 —�
Signa ure •
T a' 3
Dated
OFFICE OF THE TOWN CLERK Oc�Vtrg(,i',;'�
Town of Southold Ni (Oy
Judith T. Terry, Town Clerk .. ,);,.1.:4 r: �; •
Application No.l��
Town Hall, 53095 Main Road o tx: -,F: Construction '�
13. O. Box 1179 j��• �•T;
Southold, New York 11971 �•• cn• O� Alteration
Telephone / '01 .r/ii �� t� Residential `�
(516) 765-1801 "P.'' Non-Residential'
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT .
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE 7- L p- 2
APPLICANT NAME: .S)dtiJe .L Cyte//3 f ts+K
APPLICANT ADDRESS:
(2,5-_?D D Tv a a-t-t, /3 06 cr'
• Giz,oeti ?oa7- Ny, • /l ?yy,
SEPTIC /CESSPOOL -
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
..5)P0? 19 Fr/ 1 i�. .1 e it,/,,,y pqcP.. ) 1,
5, Fezr
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: _ci d N . ► li-7 /9 L SK
OWNER MAILING ADDRESS: 46-,300 ma!Irk Ao4d
GAeew p or47- / y J/ 9yy
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT,
PERSON: 1,07'7 - Pcp 9 0
CJ
TAX MAP NO. : Sectio Block Lot J(�, a
--
. CROSS STREET:
900 1'P e T C'as"- o f Qi e e ST,
BUILDING PERMIT NUMBER CROSS REFERENCE:_.
. :ignatui o ,pp--c
RECEIVED BY:
own Clerk's Office
DATE: � D � '3 •
1
7 X
r;-•-cEssrooL / •�• \ SUFFOLK CO.HEALTH DEM.APPROVAL
...�,-,�•��... MAP': .OFA ' P rZoPE 1+.s. NO
4' //f••/e" rJ k t.. 4�, 4 U EYED FOR Aq 1113e�+wI a will iwillMfd 9d 3�i.M ,
• ... r /1 ... ,.i 'y "' 5If EY D. CYf !✓A� v' '
. .9�` �, SINGLE FAMILY OWELLNO ONLY
.P / ` AT D PNL TINE YEARS TROY GATE Of APPROYAt,
S� • ; • .M' GREEKIPO12T STATEMENT OF INTENT
,. �, t✓' ;gyp. y .,
ti �i • // '+'CESSPOOL THE WATER SUPPLY AND SEWAGE DISPOSAL
j/ , p� T�49hi OF SOU7H�?tpNY. yo' SYSTEMS FOR THIS RESIDENCE WILL
/ . d
O
CONFORM TO THE STANDARDS OF THE
/f AQP /t �^ ,(3- e.„:„....09,.-G,2 SUFFOLK O. D PT. F H ALTH SERVICES.
O, N/F CAPfKLt►J Es"- Q• (5
1
/` / APPLICgNT
p -S. tn
f w / \`•P,%.,
�r? N � $ ^ SUFFOLK COUNTY DEPT. OF HEALTH~
// 4 4'1 �' �I
15e& +01
SERVICES — FOR APPROVAL FOR
/ CONSa �• .• S75421'40 E. 26328 r/� DATETRl�jIOf N
' 131.15 132.19 (• O—
' . O \ A� Irv, �' '- HH.S.SREF.NO.: II .
Ni
\•' ``. ` / ��c �� SUFFOLK CO.TAX MAP ESIGNATION: 1
f _ .N.
` 'P `., .2? O DIST. SECT. BLOCK PCL.
�- "A e , ��/ I O `��� OWNERS ADDRESS.
�c ` �3, 4 't OO 41,0 .� c N D laoft '�k
11111/ • {•
65300 NQR H tEQA0
' I i . ` �[�Y/, GREENIMR.TI�Y 1,944
01 4,2 L
f 1 , 2 r>xsr HO --•i�J o �' ,�. . (SROq77.88�0
?/t± x o \----t_ J� •1a� O DEED: L. P.
• tial ,t4, 6, 161L X92 �
�`(� TEST HOLE STAMP
1 Pt /41 J `/ 04s q',7).41 4 �,`• , UnautlwA:od alteration or admlbn
of
f. i!, ` u L' '1 , Secctloon 7208 is
c,New York Stale
1,f� Z• \- -Y Z Education Law.
t T- ,'s� 11I <. ; 1 T or s o�1. Copies a ens survey saw not gamin
\ ` .... .. .._ i• the land surveyors inked seal or
iii embossed seal shall not be considered
1 \� r X00' Q• ` ' 1 LOAMt to be•sendrue iX9Y.
\ \ \ �n —
/ S. ` t••
" �' 3 Guarantees Indketr lrraonstW ran
t � • n N -��.r��1`'Sv,s_1 _.-- -- - onytotMperson bwhom the swwy
and
��--t—� SAND is prepared,and on his behaMbthe
1. _! • \ ^ Y ` O!, �•,` rC]�=MONUMENT tmecompany.yo+ernmenmlapertyand
- -�� ��, .O L. 0,PIPE 1 CLAY only
to�asd9neesofthelInstitution listed adgkrtl-
N/F N.PETI IFAS f, * 1 5�auon.cwranteecare not trmahra6t.
\ 0x ,�, \ ,\` Af2EA+91,2505.F. , Gadddrato-s9wrarsorra+Wsgtwt
0. K`% Y�4 t SAM O
4 , \. a �0 ,-tis • ABSTa.T NO.mum-so'
aiOTES� �- `� 5/ ‘' °I�� MAP AME'4PEO-MAR,1.1993" MA gg.8,19 . CtAVIIL '�o..•
r1E
L LOT NO'S.REFE.'t TO A_M P.tO2 SUM:WV:SION ^;S s.. 4,2
,7,• t' GUAR1VdTEED� 1'Q` y�r,09:
MAP eaC THE EMIt.''CNICLIN ESTATE (,j- r
r r ` , SECUQtTY TITLE RC NTYCQ. 6R WATYR 1O• y to 0.
2./ ' •.C4 TiV► MAP DATAJ030-049-.8:10.2 o 4 e, U2VEYED t"IAR.3.199i2 t* /, r
_.. _ _— MAP AMENDED.JULY 13,1993.
RODERICK VAN T VL P C. °
3.GONTpUfZSt ELEVATION REFE210 MEAN_ SEA LEV&i�, /C,. ✓–.-- t ;^t,, Na tsasree ,`
`Q� 1 '`� . °LAN° J'
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`% T.S M.?ETI6tAS LICENSED LAND SURVEYORS r 17' '
• �,� GREENPORT NEW YORK :,
Tt ,M POST ,..III
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