HomeMy WebLinkAboutDoroski, David •
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JUDITH T. TERRY :,
TOWN CLERK Town Hall, 53095 Main Road
• c ,Z : P.O. Box 1179
t. 1$ . l Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = 0 �. �� Fax (516) 765-1823
MARRIAGE OFFICER a
RECORDS MANAGEMENT OFFICER =741 * `Pool.�� Telephone (516) 765 1801
FREEDOM OF INFORMATION OFFICER �����iwoo
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
. OUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1110 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ROBERT D. HEISS
Address 1 : P. O. BOX 593
City St Zip GREENPORT NY 11944
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 #R10-94-0028
Name Of Owner DOROSKI, DAVID AND DAWN
Mailing Address 1 420 FOUNDERS PATH
City St Zip SOUTHOLD NY 11971
Property Address 1 1374 LIGHTHOUSE ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 50.00 block 5 lot 6.000
Cross Street SOUNDVIEW AVENUE
Building Permit Number Cross Reference:
Issue Date: 4/04/94 Judith T. Terry
Southold Town Clerk
TOWN SEAL_L
40 A yam;
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK O P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �' Southold, New York 11971
MARRIAGE OFFICER yQ �° Fax (516) 765-1823
� i ������ Fax
(516) 765-1801
, 'of°.
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1110 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ROBERT D. HEISS
Address 1 : CLEAVES POINT VILLAGE CONDO
City St Zip EAST MARION NY 11939
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 #R10-94-0028
Name Of Owner DOROSKI, DAVID AND DAWN
Mailing Address 1 420 FOUNDERS PATH
City St Zip SOUTHOLD NY 11971
Property Address 1 1374 LIGHTHOUSE ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 60 ' block 5 lot 6.000
Cross Street SOUNDVIEW AVENUE
Building Permit Number Cross Reference:
Issue Date: 4/04/94 Judith T. Terry
Southold Town Clerk
(TOWN SFA' 1
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es 0' \\MIL it ///
OCOG —
ot-JUDITH T. TERRY :1' •
\ Town Hall, 53095 Main Road
TOWN CLERK t o rrri P.O. Box 1179
\� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ‘%410.4.
Vv C. *' Fax (516) 765-1823
MARRIAGE OFFICER _ ,,��jj�� �� ��� Fax
(516) 765-1801
RECORDS MANAGEMENT OFFICER '�"K/1 *r�ri°
FREEDOM OF INFORMATION OFFICER „„,,,ii
OFFICE OF THE TOWN CLER
TOWN OF SOUTHOLD D 1 1 11 R ro
11. eit
TO: SoutholdTown3 0 �g
Building Department i
FROM: Linda J. Cooper, Southold Town Clerk's Ofice r0 f,”; ,....._
DATED: March 30, 1994 � +Oc.1;.
Transmitted herewith is a copy of application No. 1147 for a Cesspool/
Septic Tank Construction Permit submitted by:
Robert D. Heiss (under contract to purchase) •
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: S-C7VD Or/C, /9/O - 9V —0e)2-(
MAR 11994 ' �', ,
Signature .� Or
Town Clerk Southold 3 3% V
Dated
OFFICE OF THE TOWN CLERK �c§IfFOC (`O
Town of Southold \,'
,: x t, Application No. //
Judith T. Terry, Town Clerk .t
Town Hall, 53095 Main Road 8 _ Construction
cn ` err
P. O. Box 1179 0 �
. %) Alteration
Southold, New York 11971 °�';
Telephone '_1 * 't i Residential
(516) 765-1801 "' Non--Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 44k/W ..709r /911/
APPLICANT NAME: ga6/2 r - /167-5.-5
APPLICANT ADDRESS: CLL/qv/L 5 J /MJT V<LL KG Li 6,A/be:IA/MD i C4IT /6;=/
Z5'2-0 5/1/PMAO 141(74'. 6i¢s r414Rid,0 ,UJ' //139
SEPTIC / CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
M k1 80<LbMr& ( j 64x,/4 y /4UsG)
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 2)040b . 2/r4sAh41 b02051c1
OWNER MAILING ADDRESS: UJti, 1"D viu.bcc-i2S rr477)
0r4 n L.1:0 A/ i<
OWNER PROPERTY ADDRESS: / 3 74' G,. L e “, f
_i wc.6,-1 am ,,/
TELEPHONE NUMBER OF CONTACT PERSON : .576, .. 1/77- 3f 'T
TAX MAP NO. : Section 0.6O Block 5 Lot b
CROSS STREET : Lgvii rtio us 1v
BUILDING PERMIT NUMBER CROSS REFERENCE:
/2/441/04-4-4
Signature of Applicant
RECEIVED BY: _ 4/
—77
T•wn`ler ' Office
DATE: C3
/2 ‘L,
•
- - , . ..
/ SUFFOLK CO.HEALTH DEPT.APPROVAL '
7O H.S. NO. r
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FINNS
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pplacedt, I.1l�r dri,re y n;ea. /
_ T,{
I — — ----- -- - -- - -- STATEMENT OF INTENT
I } { t Inc;` 1:2c.1-z. THE 5 Y ANDSEWAGE DISPOSAL
L!,_F. ---r IJ:L.' , N 48's. .0 F. IS' , 1 15c3.iXJSYSTEMS FORSUPPLY
RESIDENCES WILL
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.I . WATER
{C 2IGNT :F I 2�! r r- T ` ^` r ' '' ' rm y 1 /` ` (.� CONFORM TO HE STAND RDS OF THE
WtiY 14, r (h L. L._ t^—K —. Y %_1 .--.—i 7 ic� i� •I Iy,{...i SUFFOLK C PT. H LTH SERVICES.
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2t7+To'L-'`51- 1-7,-): -. `J- 5 `^./ICE UT'L11Vi EA�f.MEPNTcii APPLICANT
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PROP. ...,..-
__';_-..11 ^ �i5. / SUFFOLK COUNTY DEPT. OF HEALTH
`fpTIC Il. ! TJ Vv'�ti '•.�� l.'-' ... „-•r•
r' _– SERVICES – FOR APPROVAL OF
4i , —k'— ,IgG1' CONSTRUCTIONON;f.� q
St ;:.§ c,3 194
DATE:
V) '� PrLon'v• Hnu5FI *r 1 H.S.REF.NO.: 'D' E6 —:-.%:91:1?�
Iv i36--': --1 j ! j '\ APPROVE
,ti + ID 5 r fru• j z ! \ SUFFOLK CO.TAX MAP DESIGNA ON:
I C - 1. I Q I Z �O V' DIST. SECT. BLOCK PCL.
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V��11 /% OWNERS ADDRESS:
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ffl 7 `In � st *kli,i / t9 S DEED: L.'TJ6o P. ?cJ. jjr'.F'F;.)
- I ``Q` O TEST HOLE STAMP
l CV
��� SCALE-4 d: I. 5. O uneutlwdzed aaerenon or.ddilca
it) oN.
to this wrvey b a vblaoon d
p>` I AQ E A'24 19? Vii.F. ›. Pitig; semen rzca a b»New Yqk t3lala
cOpies
ILi7"- -. _ wE4L (hj i. aCA TOPSOIL Ea uw. I
< r'4;�-4'40' - .' i—e' :��.�, iii_ Nelend myon Ye wa""'q
�'Y _.._-. embossed seal shell not be considered •
r to be a wYid true oopy.
�.83 .__:.,;, W Guarantees Indicated hereon shell run
OLSEN M sAnin# Only
E S � GRAVEL wa parthe eed°ae i,lor whom
behatltot,ems
/12t° '. (12f_—„�C?t .;y. tele roanr.gow,mmental agency and-
4 i ; �) - . ! lending Inst tut:co listed hereon and
7 M to the as.i.r ;t t the lending heti-
. ' .. fY lotion.Gt _not renaierable
RRWYyy.. • �: CC
V to add tios..l 4.,..........4 w cuyaequeia
-;�.
' -WELL • �' {7pYC, --112 Owners.
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' WHITE. SEAL
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NOTE e r�F �vw`o
CO NT OUt2 DATUM: MEAN SEA LEVEL. —_— IA ,0.34 °may,
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. LICENSED LAND SURVEYORS=
..t GREENPORT NEW YORK
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