HomeMy WebLinkAboutBrown, Daniel � O
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JUDITH T. TERRY Town Hall, 53095 Main Road
• P.O. Box 1 179
TOWN CLERK
REGISTRAR OF VITAL STATISTICS tr) � Southold, New York 11971
MARRIAGE OFFICER yQ �- Fax Fax (516) 765-1823
� � Fax
(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. 813 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JOHN BZEZINSKI
Address 1 : 17 TACOMA LANE
City St Zip SYOSSET NY 11791
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 ON 3/6/92.
Name Of Owner BROWN, DANIEL AND MILDRED
Mailing Address 1
City St Zip 0000
Property Address 1 WATERSEDGE WAY
City St Zip SOUTHOLD NY 11971
Tax Map No. section 88.00 block 5 lot 54.000
Cross Street RAMBLER ROAD
Building Permit Number Cross Reference:
Issue Date: 3/23/92 Judith T. Terry
Southold Town Clerk
(TOWN SFAI 1
/
,44.14FOLK�D�i
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ` =O T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS . C . Southold, New York 11971gr
MARRIAGE OFFICER �O �. �I, Fax (516) 765-1823
7 0 ��' Tel (516) 765-1801
%Noiiiit 10
OFFICE OF THE TOWN. CLERK
r1c4IAE
TOWN OF SOUTHOLD R I T 19Ee
To: Southold Town Code Enforcement Officer BLDG v=
From: Linda Cooper, Southold Town Clerk's Office
Dated: March 16, 1992
Transmitted herewith is a copy of application No. 832 for a Cesspool/
Septic Tank Construction Permit submitted by:
John. Bzezinski .
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 recommendations:
APPROVE
DISAPPROVE
Comments: om a s�v ocatc,s3ALS1, %AAA,
V-1/41k %‘:ar,.& . sta.S.,4&ThStrt.
V`° 02-3 44.4-eL
Signature RECEIVED
Dated �.. MAR 2 3 10
Town Clerk Southold
r a
OFFICE OF THE TOWN CLERK
Town of Southold K `may Application No.
Judith T. Terry, Town Clerk ►� r', -;'
Town Hall, 53095 Main Road
P. O. Box 1179
En W`
, ''.4,17,4;: Construction
Southold, New York 11971 '` Alteration
Telephone 1 sc t1fv Residential
(516) 765-1301 " Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
•
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 3—
APPLICANT NAME: -.)4:0j4,J 312.&-`2.I � }
APPLICANT ADDRESS: f QAC®4 , LA .
Syoss 7 N y y _ 1-79r
SEPTIC V CESSPOOL `�
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
KEW SI 4aLLN{ t14 nEnc.64
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: D,6J4 jE'L 4- MZL.Q,i Q 2Q.0j/Vt .
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
2-5;
TELEPHONE NUMBER OF CONTACT PERSON: (5-14;;;)_
TAX MAP NO. : Section as Block �J Lot `jG,
CROSS STREET: 12,6,M' Q p D T'ER � — WAy
BUILDING PERMIT NUMBER CROSS REFERENCE: .
Signatu Applicant
RECEIVED BY : RECOVER
Town Clerk's Office
DATE: MAR 16199?
Town (mak SwthId
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1'1 ( _ .
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rI SUFFOLK CO.HEALTH DEPT.APPROVAL `Y
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H.S. NO. !<
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01
u7,
f, ;5: .5, r r
- 'N ='�1 VACANT) THE WATER STATEMENT OF INTENT
SUPPLY AND SEWAGE DISPOSAL
50 O SYSTEMS FOR THIS RESIDENCE WILL
LG CONFORM TO THE STANDARDS OF THE
r 1 M P OF PROPERTY a SUFFOLK C DEPT. faF ALTH ER VICES.
.p1- S.66D22..I0, E. 116.6$ a+ ? SUi v:YL ✓ F G`Z Z•:( S j0
.____ _ _ F _ ( 0 W. ` I PLICANT
PROP.SEPTIC .- u�. (ll 2�� f) L.101-41\ R BZ 1....Z I 1 V S I�I Z W
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' '- 'C� SUFFOLK COUNTY DEPT. OF HEALTH
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_ + :` � SERVICES FOR APPROVAL OF
`� �O` SS L� � `l Q i` AT 1 J 0 CONSTRUCTION ONLY
,'P:.v� `�,' I i— -, t�Y1!'E' fY. W DATE: 3—C�—�'�
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Y I 1 PROP,v IVE I� l +�` H.S.REF.NO.. /�` S _ /
TC WN t:4 :C UT• ,:.);.v NE 'v! '! .� [�Q APPROVED:
LC
��. • r' >-4. .3ga a L,i( 300
Ir
GAR. \ \ (0 SUFFOLK CO.TAX MAP D IGNATION:
1 ` \ DIST. SECT. BLOCK PCL.
x \ \ 4c a IC.".--)0, :..,:..3'...::: '...-5.3
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W OWNERS ADDRESS:
L�._..-_ J 1rtj
�. -% i '2Cd P HO• ( Jt tj Q 17 TACOMA IAEA[
i L— > 0. SYOSS E r,N.Y.11791
La
in `4 v,ce 516-496 4996
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