HomeMy WebLinkAboutDroskoski, Kirsten SCUTHCLD VASTEVIATER DI SPCSAL PERM T
CCVSTRLICTI GN CR ALTERATI CN PERM T
SEPTI C TAN< or CESSPCCL
Per m t Nb. 4200 R Rlesi dent i al X Nin-Resi dent i al
Fee $ 10. 00 Septic X Cesspool
PERM T I SSLED TO
Nam : MRI S CESSPCCL
Addr ess 1: 2760 YEN'ECCITT DRI VE
CI t y St Zip SCUfHCLD NY 11971
Descr i pt on of Proposed Const r uct i on or Al t er at i on
AUDI TI CN TO EXI STI NG SYSTEM
APPROVED AS SWM TIED NAI NTAI N FEW FED SETBACKS RCM ADJACENT
V'ELLS, BU LD NGS, PRICPERTY LI N=S AND MATER BC] ES
EXCAVATI CN I NSPECTI CN REW RED
Name a OAner KI RSTEN DRI SKCSKI
Mai I i ng Addr ess 1 22345 WI N ROAD
Qty St Zip CUTCI-IOQE NY 11935
Property Addr ess 1 531 STEW NG PLACE
Qty St Zip C E�EEN'CRT W 11944
Tax Map Nb. section 109. 00 bl ock 1 I of 6. 000
Cross Street ELI JAHS LAM
Bui I di ng Per m t Nunber Cross Fef er ence:
Issue Dat e: 4/04/ 14 Elizabeth A Navi I I e
Sout hold Tow, a er k
VFW
sN
ELIZABETH A.NEVILLE,MMC ��""��� �4% Town Hall,53095 Main Road
TOWN CLERK p Al P.O. Box 1179
t H : ; Southold,New York 11971
REGISTRAR OF VITAL STATISTICS `�' ��
O 0 Fax(631) 765-6145
MARRIAGE OFFICER 4.. 0. / Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER (fd ,�► a,... www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER —.." ......00
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD --
TO: Southold Town Building Department i `; "
_ 8 2013 r i i
E LL MAR '
FROM: Carol Hydell, Southold Town Clerk's Office I.
DATED: March 8, 2013 l___..__"' n.r)
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4200 for a Cesspool/Se?tW a&C nssttruc�ti
Permit submitted by:
_ MAR 1 8 2013
Morris Cesspool for Alec,Anna
BLDG. DEPT.
Please review the application and location map and advise if this office may issue the peiTmir.oF SOUTHOLD
Please complete the form below and return it to me. Thank you.
* * * * * * * * * * * *
I have reviewed the a. . ' . 'I • • i s . '. - ap of the project cited above and make the following
recommenda 't :
CV� y,,` ,""° >3 e4 c-- -7-".�.c '—
• PPROVE
DISAPPROVE dti.,...de-s-k-
Comments:
7f.r............. .4,
Signature
6)34'49/3
Dated
TIMiiii'''''''''''''''''''''''''
to'
ELIZABETH A.NEVILLE •. `Z`� cGy\ Town Hall, 53095 Main Road
TOWN CLERK p — I P.O. Box 1179
REGISTRAR OF VITAL STATISTICS $ Southold, New York 11971
MARRIAGE OFFICER : `F 1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER .y t)'•0 Telephone(631) 765-1800
'
FREEDOM OF INFORMATION OFFICER - '� 4, -0, ,' southoldtown.northfork.net
--"------.00
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 or Non-Residential @ $25 Application No. I )41"
Permit No.
Applicant Name 7/4 ^6 ; s age`'o
Applicant Mailing Address 02 766 , t iJ N L Co 17 i"/4
90 c,,
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration p UR A oz-•>
Location of Proposed Construction/Alteration:
Owner of Property: 4i) l7 tJ JJo54s(c
Owner Mailing Address: 2 2 Sys^ /n p_, /j60
cu,4G441,.... id y // c 3
Owner Property Address: '31 ,S'is.,e/( 7 (
CRipope„ r 4)i
Name and phone number of contact person
Tax Map No: Section /09 Block / Lot b
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL p
b xi /7ie 444(-,
wl_
0
Signatu a of Applicant Date
Received by:
0 0 \ ae,r, itreA
cop, (v56.1 0 <-
(& "-/ed
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