HomeMy WebLinkAboutDoroski, John ,,oc�FFo��r�D�
JUDITH T. TERRY L : Town Hall, 53095 Main Road
TOWN CLERK : o T P.O. Box 1179
cfs Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ‘‘ VA, �. Fax (516) 765-1823
MARRIAGE OFFICER _ ��//�� �O ' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER — '+(/1 �/,..'
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. 1162 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOHN S. DOROSKI, JR.
Address 1 : 16 MIDDLETON ROAD
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 #93-SO-35
Name Of Owner DOROSKI, JOHN S., JR.
Mailing Address 1 16 MIDDLETON ROAD
City St Zip GREENPORT NY 11944
Property Address 1 12 MADISON STREET
City St Zip GREENPORT NY 11944
CC c/
Tax Map No. section 34.00 block 1 lot 398- 3 bO
Cross Street NORTH ROAD
Building Permit Number Cross Reference:
Issue Date: 7/07/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY ; Town Hall, 53095 Main Road
TOWN CLERK
o T : P.O. Box 1179
Vs �� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO �. �,? Fax (516) 765-1823
MARRIAGE OFFICER '-- _ 1 + 'Woo'
FREEDOM OF INFORMATION OFFICER = „�li„ii•��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 29, 1994
Transmitted herewith is a copy of application No. 1206 for a Cesspool/
Septic Tank Construction Permit submitted by:
John S. Doroski, Jr. .
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. D Q _ rn
ffni
Thank you. lr! V
-"1
JUN 29199
DEPT.
Linda J. Cooper !,..4.1.t. �' • D
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE Z-
DISAPPROVE ,r�
Comments: ,ii--' ,re !�` 93— Jo — 3 .,-
Signature
Dated �� 4"
OFFICE OF THE TOWN CLERK c$FU13j
Town of Southold 0� . � CSG '
Judith T. Terry, Town Clerk Application No. Jai
Town Hall, 53095 Main Road `cr3G ., 'fi Construction
P. O. Box 1179 .` J
Southold, New York 11971 Alteration
10 �� " Residential
Telephone ✓�—
(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 JOY1 / / 7 / V
JOhfl �APPLICANT NAME: , .DD ros ll / , �.J (•
APPLICANT ADDRESS: / //) l40e-ton /\Or
G're j'Iport / �' / l ? `f�f
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTI N OR ALTERATION
S / � � Fq,rl / .D , e, IPn -
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTIONIOR ALTERATION:/
OWNER OF PROPERTY: t,J O 4I S, D r'b .$lel./ /
OWNER MAILING ADDRESS: / 6 I Coot,
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OWNER PROPERTY ADDRESS: 1 01 1.50 5
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TELEPHONE NUMBER OF CONTACT PERSON: (-5--/ ) �7 3.-33°
TAX MAP NO. : Section 3 Block / Lot
CROSS STREET: /VD 1' / A
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signatur- .f Applicant
RECEIVED BY:
own Clerk's Office
DATE: 77 /IX
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