HomeMy WebLinkAboutAnderson, Brad JUDITH T. TERRY :,Z • Town Hall, 53095 Main Road
TOWN CLERK : =v nz+ : P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO �,� Fax (516) 765-1823
MARRIAGE OFFICER ' '`,1 ��O ,$ Fax
(516) 765-1801
RECORDS MANAGEMENT OFFICER 1 'fe.
FREEDOM OF INFORMATION OFFICER „i,,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1245 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : STANLEY F. SKREZEC
Address 1 : 50 GULL POND LANE
City St Zip GREENPORT NY 11944
Descripton of Proposed Construction or Alteration
FILL IN OLD TRAP, USE EXISTING POOL FOR TRAP AND ADD TWO CESSPOOLS.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner ANDERSON, BRAD AND FRAN
Mailing Address 1
City St Zip 0000
Property Address 1 PRIVATE ROAD (EMERSON ESTATE)
OFF SOUTH HARBOR ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 86.00 block 3 lot 2.000
Cross Street HIAWATHA'S PATH
Building Permit Number Cross Reference:
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Issue Date: 11/15/94 Judith T. Terri”
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY % .. L ; Town Hall, 53095 Main Road
TOWN CLERK : p r= : P.O. Box 1179
tl'� ,' Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ‘V ''I Fax (516) 765-1823
MARRIAGE OFFICER ==.�`,� ,, ) °� Fax
(516) 765-1801
RECORDS MANAGEMENT OFFICER . 1 , .
FREEDOM OF INFORMATION OFFICER = „„/i/,r,r�r
OFFICE OF THE TOWN CLERK ;(s C? ` % ”
TOWN OF SOUTHOLD
TO: Southold Town Building Department NOV } 4 Mal
FROM: Linda Cooper, Southold Town Clerk's Office 1
DATED: November 14, 1994 DEPt
TOWBLDG.O OUTH OLD
Transmitted herewith is a copy of application No. A1291 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Stanley Skrezec for Brad and Fran Anderson ,
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 - EXCAVATION INSPECTION
DISAPPROVE - REQUIRED
COMMENTS: Maintain required setbacks from adjacent wells, buildings,
property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
•
Signatu:rr 4
Date
OFFICE OF THE TOWN CLERK ,�,'"'"
Town of Southold or
Judith T. Terry, Town Clerk ;' � G Application No' ?(
Town Hall, 53095 Main Road Construction
P. O. Box 1179 Alteration
Southold, New York 11971 N T:
Telephone =O, . ��sr $10.00 - Residential
(516) 765-1801 11 ,, �' $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ , L
DATE NOV l '7 / 9 y _
APPLICANT NAME: STYJJS (ZjZ.e-Gr
APPLICANT ADDRESS: 54 GU (_,L. PO/•'b
G io,c f (t'Vv
SEPTIC CESSPOOL X
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION f/( /
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: (3/ZA D ,4 'b 'F W - JA co,.,
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: OLD F44499-Savk - '( /�q,•aji 0c--Fi4Rwis
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TELEPHONE NUMBER OF CONTACT PERSON: 1-1 - / 8 2-2.-
TAX
-ZTAX MAP NO. : Section Y('' Block Lot
CROSS STREET: i/d A-4 cS ?MA
BUILDING PERMIT NUMBER CROSS REFERENCE:
Sig ature o pp,; ant'`
RECEIVED BY :
Town Clerk's Office
DATE:
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