HomeMy WebLinkAboutSzydlowski, Carolyn SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3962 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : COASTLINE CESSPOOL & DRAIN SVC
Address 1: 4225 BRIDGE LANE
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner CAROLYN SZYDLOWSKI
Mailing Address 1 1060 MCDONALD AVE
City St Zip WANTAGH NY 11793
Property Address 1 4800 PEQUASH AVE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 110.00 block 3 lot 28.000
Cross Street SOUTHERN CROSS ROAD
Building Permit Number Cross Reference:
Issue Date: 7/16/10 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE,RMC,CMC 1 ,O l0 : Town Hall, 53095 Main Road
TOWN CLERK * lli[, P.O. Box 1179
N Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS ; G � ,�
MARRIAGE OFFICER '� �O �1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER '�I Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `O.COUIY I i,'°"P.
,Ii , southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
JUL 1 3 2010
FROM: Linda J. Cooper, Southold Town Clerk's Office
BLDG.DEPT.
DATED: July 12, 2010 TOWN OF SOUTHOLD
Transmitted herewith is a copy of application No. 3962 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Coastline Cesspool & Drain Service for Carolyn Szydlowski (SCTM 110-3-28)
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 me.
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings, property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED. .
T
Signature
0 7AADated
• •
,,,,,,,,,. -__-
ELIZABETH A.NEVILLE ;,'h� Town Hall, 53095 Main Road
TOWN CLERK P.O.Box 1179
REGISTRAR OF VITAL STATISTICSA Southold,New York 11971
MARRIAGE OFFICER F�t, Fax(631) 768-614b
RECORDS MANAGEMENT OFFICER '; stet). Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER = '� ;,�'� southoldtown.northfork.net
,,
OFFICE OF THE TOWN CLERK RECEIVED
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT JUL 1 2 2010
APPLICATION
Southold Town Clerk
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 V or Non-Residential @ $25 Application No. 396
Permit No.
/-1 t( y
Applicant Name (.3Ca. L\ f\ C5A (-4 Ci)s(Iic\SQ
Applicant Mailing Address 4x45 ES Lr ,
Septic Tank ✓er•Cesspool ✓
Brief Description of Proposed Construction or Alteration A (w \C.v()/A\r\ 3t }lc
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Location of Proposed Construction/Alteration:
Owner of Property: C�r \cLi
Owner Mailing Address: \OLD 0 fYlc c�s�\d PI.>c
Owner Property Address: LA t r o„S Y\ .
Name and phone number of contact person 1_A+ \\- 5..>1Lo-C't0 "
Tax Map No:\000 Section kaffilft\\0 Block S - ,, Lot
Cross Street jcA c,(1 C-4‘. SS 'L<:,c,
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
(,
Signature of Applicant Date
Received by: A947t
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- VEY OF PROPERTY
SITUATE, CUTCHO6UE N
TOWN! SOUTHOLD
SUFFOLK COUNTY,NY
W. - _ -E
SURVEYED 06-28-01
SUFFOLK COUNTY TAX M `6,G Ce., e96A/ 5���43
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1000-110-3-28
CERTIFIED TO, G �� . 14!, ?4 iS 4
EILEEN H.MC.CARROLL (// !/
PHH MORTGAGE SERVICES �yy��
COMMONWEALTH LAND TITLE INSURANCE COMPANY ,vT/1� � ,( ,fjyn �e j'6/r8
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NOTES. -�
• MONUMENT FOUND
AREA = 26,250 SF OR 0.60 ACRES JOHN C. EHLERS LAND SURVEYOR
r 6 EAST MAIN STREET N.Y.S.LIC.NO.50202
• GRAPHIC SCALE 1"= 30'_ - RIVERHEAD,N.Y.11901 REF.\1Hp servea\d1PROS101-2I5-pro
-- - 369-8288 Fax 369-8287