HomeMy WebLinkAboutBladykas, William „ , ” '-.
JUDITH T. TERRY % Z : Town Hall, 53095 Main Road
TOWN CLERK T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS Gri Southold, New York 11971
MARRIAGE OFFICER \V Off(' � Fax (516) 765-1823
_,�rjl �� � Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1088 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : WILLIAM AND LAUREN BLADYKAS
Address 1 : 2240 MARLENE LANE
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLD COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #93-SO-88.
Name Of Owner BLADYKAS, WILLIAM AND LAUREN
Mailing Address 1 2240 MARLEN LANE
City St Zip MATTITUCK NY 11952
Property Address 1 235 PASTURE LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 17 lot 17.005
Cross Street MEADOW BEACH LANE
Building Permit Number Cross Reference:
Issue Date: 1/28/94 Judith T. Terry
Southold Town Clerk
[TOWN SEAL)
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JUDITH T. TERRY : t Town Hall, 53095 Main Road
TOWN CLERK : o T P.O. Box 1179
EP � Southold, New York
11971
REGISTRAR OF VITAL STATISTICS ‘%40642‘,.
VO �� Fax (516) 765-1823
MARRIAGE OFFICER .,'`jam ��40-•�� Fax
(516) 765-1801
RECORDS MANAGEMENT OFFICER _ ,` . ,,i� € i,.,,,,”,,,,,,. , -
FREEDOM OF INFORMATION OFFICER = „,,,�i,� ES)!:a ( r
fi V.
OFFICE OF THE TOWN CLERK i JAN I 0 fir,,.
TOWN OF SOUTHOLD i i t I
TOnsA
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: January 10, 1994
Transmitted herewith is a copy of application No. 1123 for a Cesspool;
Septic Tank Construction Permit submitted by:
William and Lauren Bladykas .
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 reco ations:
APPROVE
DISAPPROVE
Comments: Sd WO 93--So _eF
77,Z2::
Signature,/�-1c—
/ /3117
i( IWDated
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OFFICE OF THE TOWN CLERK c�r1=U(,�
t r Town of Southold G,% O�
Judith T. Terry, Town Clerk �'•' ` ` ` �j
"� "-r" Application No. /4�3
Town Hall, 53095 Main Road tc `1'`_ .,.
•
P. O. Box 1179 F , ;: Fn Construction L-�
Southold, New York 11971 O:' `X%` r
e;%• '0\-c� Alteration
Telephone 1 �` s 1 Residential ,-/
(516) 765- 1301 . ; ,�r�9
Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE t° /9y
r
APPLICANT NAME:
APPLICANT ADDRESS: D • `/ , e. / „
�-�'7"I'u e-
A ' at' C _
SEPTIC CESSPOOL _
DESCRIPTIO OF PROPOSEDSTRUCTI•
l OR ALTERATION 577
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PM* aAG' 4 c, ,s , ,1 s. ./.g/
el 1.-----. o, PO " - . d K-€-h-r- • 4.--
LOCATION MAP: Must be attached hereto before permit maybe issued.
ed.
LOCATIO�J •
OF PROPOSED CONS RUCTION O• ALTERATION:
• OWNER OF PROPERTY: j
• OWNER MAILING ADDRESS: 22 0 JI e - / �,u _
' //fs2_
OWNER PROPERTY ADDRESS: S- `'
7Y14-.A.,r.; e L- - . .
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /( Block l Lot S
/ �/'
. CROSS STREET: /1 JO . ;.ef epi
BUILDING PERMIT NUMBER CROSS REFERENCE:..
1'
- I () Li a' : S
Sign urel�<rt�
of Applicant � '
RECEIVED BY: 4 �:
owr Cie k's Office
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DATE: / 6 9V
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