HomeMy WebLinkAboutAndrejack, Thomas ,'
Town Hall, 53095 Main Road
cfs
‘10&_ . ��� P.O. Box 1179
�0��' Southold, New York 11971
'�
+ �
JUDITH T.TERRY =: , 0TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR Of VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 430 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ANDREJACK, THOMAS
Address 1 : ANDREJACK, CATHERINE L.
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES, DATED 11/29/88.
Name Of Owner ANDREJACK, THOMAS & CATHERINE
Mailing Address 1 P. O. BOX 349
City St Zip CUTCHOGUE NY 11935
Property Address 1 DUCK POND ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 83.00 block 4 lot 1 .000
Cross Street OREGON ROAD
Building Permit Number Cross Reference:
Issue Date: 12/01/88 Judith T. Terry
Southold Town Clerk
I TOWN SEAL 1
i''' "' ' ' ',14,,IY7 a
.,
14
,,,
---
-.4
JLiu; mu ,) o0
cftfu rc
�� �,at° � � ^; *,$ Town Hall, 53095 Main Road
�--,TH \-%04,,, ' � P.O. Box 1179
OLD -_ � �• s° Southold, New York 11971
_ 1 •Ai •
JUDITH T.TERRY „i"/�i��� TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: November 30, 1988
Transmitted herewith is a copy of application No. 437 for a Cesspool/
Septic Tank Construction Permit submitted by:
Thomas and Catherine L. Andrejack
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.
-xa -
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE X
•
DISAPPROVE
•
Comments: cp ,1.��cal.a. ern - 1 ae nQ. - th.,� , ,1
1
(-)-t- -<-1-50t3dc Q.-0 k,,,,,,,,.:--- Fr, u,,N „\,., %,
C/CL-CA.4, CL ou.9-
Si nature
ROM t IA, \m,
DEC 011988 Dated
'town Oa ea"
r .
0
OFFICE OF THE TOWN CLERK S4FOC, _
Town of Southold 4 ,C34
COG /� /
Judith T. Terry, Town Clerk
y. : tit ;
Application No.
Town Hall, 53095 Main Road Construction
P. O. Box 1179 0 J Alteration
Southold, New York 11971
*01 t � •', Residential U
Telephone _
•
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ /t) --
DATE
/ 'iDATE 026, MY
APPLICANT NAME: Thom Le1>Pririe �• 11ndrejach,
APPLICANT ADDRESS: P O. d ox 349
G u/c./Joy u,e. N j /193!
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Tuiv - dory a /oi oaf s1n9fe tanii )t/ drv�i/cam ,
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: it/e. k! //i96. 7 AdlyJ ac/C
OWNER MAILING ADDRESS: f6• Bo( jig
//7M75 t& A// //q3
,-
OWNER PROPERTY ADDRESS: buck JOncI oad
z(if/alta, 7ut /193,
TELEPHONE NUMBER OF CONTACT PERSON: 7a7-/36'/
TAX MAP NO. : Section 1 f3 .oo Block 04. pp Lot 00i. 600
CROSS STREET: C-4-efall,
BUILDING PERMIT NUMBER CROSS REFERENCE:
---1/ 11,4 /R. I
Signature of plicant
RECEIVED B •iticiiiili
wn C rk'
DATE: Agaimilie N a
1988
• lawn C tai
Town Clerk Southold
,.....
.,
N/O/� 1 sr„r<'. 1„
1 ',' . •1`;-'.
NNIIIIIIIIIIIIIIIIIt KEVIN KNOBLOCH
9 VERTICAL SAND DRAIN I
EASEMENT PARAREA 3
\1 y
SURVEY OF 2� i,s'"
RICHARD E EL EY ►-- LEASE NOTE C
<«L LOT / N0�
F
ys 3s°oo'oo"w f�O 53 ' A SEs s Rear lids septic t n MAP OF Sell. cr.�
e —+ . • S cover
to grade, WOODBINE MANOR � ��N �, ,•,,L.
pND 7 fND S- sE> ( {^�Y err
STK 5?^ — S
37.2 EVER6R if-ENS """" '""' A FILED DEC. /5 /986 NO. 8239
a3 ...... - AT C UTCHOGUE , A .
Z o St.Fr;'l.K Cr`7,:r; zr RitA OF fi"rw'tri S. 4:s TOWN OF SOUTH O L ,•�
e D�
O F,�,r, .- -r`VAI. CSF Cor.:7„t,r-r...*; r1. . SUFFOLK COUNTY N.Y. -:
try WeLI N 10 v.- r 1000-83- 04- 0/ c,y 1983
c e •LOT /
DATE ) i P'7 r 1'c SCALE ! = 50 �
MAY 8, 1987 V`Y�
APPRCV D grxr — AUGUST 30, 1988 f B.O.H. )
a:
G
d
Q Q �r�, i
LOT 2
W CERTIFIED TO:
2� F `VAGArvT) CHICAGO TITLE INSURANCE COMPANY
+ N e EQUITY ABSTRACT INCORPORATED
O ip
Q THOMAS ANDRE JACK
m /-- 48'
LU W Y hepi. . 94r o , J CATHERINE L. ANDREJACK
el ..p -a• C
CE
vx C \ Prepared In accordance with the minini.r
R S. P,c
standards for title surveys as established
— �+ .y#N.r A by the L.I.A1.S.and approved and adopted
•0 \ tar such we by The New York State Land
rt \ I�'! _-. __ . Title Assoc
\14. h drruswq O
O 2 y O The water supply & sewage disposal sys-
Z terns for this residence will conform to the
0 < �`� standards of the Suffolk County Depart-
nl •
�\�2S meet of Health Services.
L _ _ The locations of wells and'cesspools shown hereon are from field
r ���� observations and or data obtained from others.
- - -- — 4 456.61
Sp., ��,-� DRA,ti'AGF_ j NI /_ - X19.7 s4r,rpc
• + 1 �9 LANDS',
N 39°00'OO"W ? / 160. 53' 9`
licffIrdki
ENG/NERS
DUCK POND ROAD )tQ496I8
• QRS\ 6i
J: o'n�44 .e
ELEVATIONS ARE REFERENCED :r�. r.
TO AN ASSUMED DATUM. , •4 MA .• A A V
�VAc i.,,T) YLJ-� ` ' ,A I' ". /1 971
\\iI
: 7 -389