HomeMy WebLinkAboutBuczak, Stephen /g
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JUDITH T.TERRY �`� � 1�t
Town Hall,53095 Main Road
TOWN CLERK vs z P.O.Box 1179
�,� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS •
11 Fax(516)765-1823
MARRIAGE OFFICER �Q 4O•oo Telephone 516
RECORDS MANAGEMENT OFFICER .� 1,� P ( )765-1800
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. 1388 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : STEPHEN AND SUSAN BUCZAK
Address 1 : 17 HARMONY STREET
City St Zip MONORVILLE NY 11949
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #93-SO-51
Name Of Owner BUCZAK, STEPHEN AND SUSAN
Mailing Address 1 18 HARMONY STREET
City St Zip MANORVILLE NY 11949
Property Address 1 470 WILLIS CREEK DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 17 lot 11 .000
Cross Street MEADOW BEACH LANE
Building Permit Number Cross Reference:
Issue Date: 9/18/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY ` o Town Hall, 53095 Main Road
TOWN CLERK ti Z P.O.Box 1179
rit
0 � Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 1
MARRIAGE OFFICER �y� 40. Fax(516)765-1823
RECORDS MANAGEMENT OFFICER -: .( lig .isd1 Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER 'v,, p•s"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD Q
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TO: Southold Town Building Department i # SNP �!
FROM: Linda J. Cooper, Southold Town Clerk's Office
BLDG..DEPT.
DATED: September 13, 1995 TOWN OF SOUTHOLD
Transmitted herewith is a copy of application No. 1440 for a Cesspool/
Septic Tank Construction Permit submitted by:
Stephen and Susan Buczak •
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: 7i 'o . SC (5 4"l
Signa . -
9 7r '
D. ed
OFFICE OF THE TOWN CLE K . rrg
• Town of SoutholdNC> . `
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Judith T. Terry, Town Cter . .: ;' _ i Application N9/&.a._
Town Haul, 53095 Main Roa 1 '— Construction L
P. O. Box 1179TV. ''
Sauthoict, New York 11971 -C!, Alteration
Telephone �f r t a1� Residential �,�/
(516) 765-1501 " • Non-Residential
• TOWN OF SOUTHOLD .
SOUTHOLD WASTEWATER DISPOSAL DISTRICT '
APPLICATION •
for
CONSTRUCTION or ALTERATION. PERMIT • .
• •
• SEPTIC TANK or CESSPOOL
Permit No.
Fee $ .
DATE 1,VP}'
APPLICANT NAME: ,4 . ,�,, /X r•
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APPLICANT ADDRESS: OP/6101,44•16A7 ,.SjL •
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SEPTIC>4 CESSPOOL -
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
ivA/461 al 7"-. - ----/I- y4 2 3 . e) L J >1f ,e-ps• ,
•
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCACONSTRUCTi N. OR N•
01'1NERTIONOF OF PROPERTY:PROPOSED ,5� 1'ALTERATIOvf,�- I�UGZ...,R• •
OWNER MAILING ADDRESS: P �rfr" d 47 4-C-1-
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OWNER. PROPERTY ADDRESS: 2O , . e","//7/7:5-- C/24-4,e .iL. .
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TELEPHONE NUMBER OF. CO TA ..
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CROSS STREET: , A41',�o w 4 E' G
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UIL..QINC-#SER. NUMBER CROSS REFERENCE:_
ignature cif Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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NOTE: O F APPROVAL
I. ELEVATIONS ARE REFERENCED
TO NGVD (MSL 1929).
2. ----8----=EXISTING CONTOUR
SURVEY FOR
ie `� �d S'vr. 5��y.�� -4o%'V/,P•V STEPHEN J. BUCZAK a SUSAN L. BUCZAK
e S r% JULY 15, 1994
SUFFOLK COUNTY DEPARTMENT Of HEALTH SEuvic.h LOT N O. I I , HARBOR VIEW AT MATTITUCK I TU C K • OCT. 25 , 1993
I AT MATTITUCK DATE: AUG. 5, 1993
FOR APP OVAL OF CONSTRUCTION ONLY TOWN OF SOUTHOLD SCALE: 1 "= 40' •
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�j,�3 93 -S(9 _ 5/ SUFFOLK COUNTY, NEW YORK NO, 93 - 0597
DATE 7 tp. • ` a uN►uTHORIZ[o ALTERATION OR ADDITION To THIS CERTIFIED TO:
SURVEY IS A VIOLATION OF SECTION no! OF THE STEPHEN J. BUCZAK
fr .
���� '" NEW YORK STAT[ EDUCATION LAW SUSAN L. BUCZAK
PPIOVEDi—�I� N COr1ES OF TNI! SURVEY NOT SEARING THE LANG LAWYERS T .SURANCE COMPANY
Ar- �� NOT VEYOR'f INKED SEAL OAVALIO TR COAL ,HALL (TIT " T '‘ , - 6342)
• I NOT SE CONSIDERED TO BL A VALID TRUE COM, l
KGUARANTEES INDICATED HEREON SHALL RUN ONLY TO
HEALTH DEPARTMENT-DATA FOR APPROO*L TO CONSTRUCT THE PERSON FOR WHOM THE $LIMEY IS PREPARED ��'� t-{ F q� YO
AND ON HIS BEHALF TO THE TITLE COMPANY,OOVEIIN- ,fin
M NEAREST W SIAIN MI. ! N SOURCE OF WATER. PRIMTE_PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED CO
O SuFF CO. TAIL MA► oisT 1000 SECTION Jam_ELDCK 1Z_Lot 17 1 I HEREON,AND To THE ASSISNEES OF THE LENDING \ C ��
*THEM ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION. GUARANTEES ARE NOT TRANJFEEBASLE * ti *.41
r - VI *
OTHER THAN THOSE SHOWN HEREON To ADDITIONAL INSTITUTIONS OR luSSEOUENT I- Z„ Iy:
N THE WATER SUPPLY AIM SEWAGE DISPOSAL SYSTEM FOR THIS RfIDENCE OWNERS ` iA►: 1
*DISTANCES SHOWN HEREON FROM PROPERTY LINES B It
WILL CONFORM TO TINT STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT TO EXISTING STRUCTURES Mt FOR A SPECIFIC I' •" .;.A%r" W/ 1.i.
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OF HEALTH IC[S. PURPOSE AND ARE NOT TO SE USED TO ESTABLISH ��f
APPLICANT• + / L
�����=�,/ ��/GZ,y/� PROPERTY LINES OR FOR THE ERECTION a FENCES <;�� 48sg9`�lt�y
ADORE SS i
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d ✓///4 .v I///YS',`5/6,?,5'" ems/z YOUNG a YOUNG .. ...-.RIVERHEAO NEWAYORK E
NOTE:Q =REBAR 8 = MONUMENT ALDEN W.YOUNG,PROFESSIONAL ENGINEER
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF
SUFFOLK COUNTY ON AUG.21, 1987 AS FILE NO. 8377. AND LAND SURVEYOR N.Y.S.UCENSE NO.12845
HOWARD W.YOUNG, LAND SURVEYOR
m *MK LOCATION OF WQLIWI,SEPTIC TANKISTIA CESSPOOLSICP)SHOWN MINION N.Y.S.LICENSE NO.45893
+ ARE PROM FIELD OMERIMTIONS MO OR DATA OBTAINED FROM OTHERS .
SRANOIS & SONS INC.