HomeMy WebLinkAboutDeroski, Robert ti
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JUDITH T.TERRYo= Town Hall,53095 Main Road
•TOWN CLERK t y 2G P.O.Box 1179
REGISTRAR OF VITAL STATISTICS O� �l•F�,, Southold,New York 11971
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MARRIAGE OFFICER Fax(516)765-1823
RECORDS MANAGEMENT OFFICER �.� 190Telephone Teephone(516)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. 1327 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : P. O. BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITON OF A NEW OVERFLOW TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner DEROSKI, ROBERT
Mailing Address 1 BOX 905
City St Zip CUTCHOGUE NY 11935
Property Address 1 4 HARBOR LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section /3ritiTin block 1 lot 24.000 a ,
Cross Street OAK STREET
Building Permit Number Cross Reference:
Issue Date: 5/04/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ` v rri P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 0 ���` Fax (516) 765-1823
MARRIAGE OFFICER ,,��jj�� . I. Telephone Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER =�"K/1 ��
FREEDOM OF INFORMATION OFFICER
--.'".-",-..,•,,, ii,,,�,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD 4
TO: Southold Town Building Department /
elan
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: May 1 , 1995
Transmitted herewith is a copy of application No. A1376 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Robert Deroski .
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 - e.
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
igna ure
Ai
949
Date
(MitaOF THE TOWN CLERK """''--
Town of Southold stgULA' '
Judith T. Terry, Town Clerk � i . Application No. /3 7(
Town Hall, 53095 Main Road ?#-. Construction /
P. 0. Box 1179 . _
rill 1
Southold, New York 11971 Alteration
Telephone Om/ $10.00 - Residential
(516) 65-1801 , deft it
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'� $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 5A/ J 5-
-APPLICANT NAME:
APPLICANT ADDRESS: " I ij� G 972_
// 5SZ
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: 6r$ 995- �.�
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OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 12-9 9c $Y
TAX MAP NO. : Section /3(,a,, Block / Lot
S STREET : G c-7"
BUILDING PERMIT NUMBER CROSS REFERENCE:
XelettAf
Signature of Applicert
RECEIVED BY:
Ti '�+�Dk's Office
DATE: NN �
MAY 1 1995
Town Clad; WIWI
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