HomeMy WebLinkAboutBroderick, Thomas ee
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JUDITH T.TERRY ` = < Town Hall,53095 Main Road
TOWN
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Z P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ‘0,4_
Fax(516)765 1823
MARRIAGE OFFICER J0 it)/ Telephone(516)765-1800
RECORDS MANAGEMENT OFFICER �
FREEDOM OF INFORMATION OFFICER ,••�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1334 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
ADDITION OF TWO 8' RINGS TO EXISTING SEPTIC TANK SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner BRODERICK, THOMAS AND JUDY
Mailing Address 1 83 IMPERIAL DRIVE
City St Zip MILLER PLACE NY 11764
Property Address 1 3585 SOUTH HARBOR ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 3 lot 8.000
Cross Street HIAWATHA'S PATH
Building Permit Number Cross Reference:
Issue Date: 5/12/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK : p r= : P.O. Box 1179
w Southold, New York
11971
REGISTRAR OF VITAL STATISTICS "-V421,. Fax (516) 765-1823
MARRIAGE OFFICER , �� ��' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ' ,l 4 1•709'
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FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
MAY H 1995
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: May 11, 1995
Transmitted herewith is a copy of application No. A1383 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Stanley Skrezec for Thomas & Judy Broderick
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 -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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L5/2-A
Date
OFFICE OF THE TOWN CLERK ,.,'
Town of Southold .0''� �FFt�K _ r
Town Clerk $44� ��l/ Application No./3
Judith T. Terry, y'
Town Hall, 53095 Main Road ;
Construction
P. 0. Box 1179 Z
Southold, New York 11971 Alteration � '_
Telephone y0,!► �Q�,'' $10.00 - Residential --� �
(516) 765-1801 = �l 4, - , s' c $25.00 -Non-Residential
• „ . ,,,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE /(iy 11 / _c
APPLICANT NAME: STI;
APPLICANT ADDRESS: 'O G-vLL * - C
G- iv p &tY'1 /t..
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION ONS -
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPO-- Y CONSTRUCTION OR ALTERATION:
'`OWNER OF PROPERTvOy E3/20P1
OWNER MAILING ADDRESS: 83 _T `1 L j yam' fit IWe. , y
--4OWNER PROPERTY ADDRESS: _ "��' j$` Sr9J-b& (}-ititQg,a, Ip
TELEPHONE NUMBER OF CONTACT PERSON: L-17 7 - 18
TAX MAP NO. : Section 1 Block 3 Lot air
CROSS STREET: ' �`” ;14-1A4444( S PAW-
BUILDING
PERMIT NUMBER CROSS REFERENCE:
Si nature g—ttleCant
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RECEIVED BY
T�Ark's Office
DATE:
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