HomeMy WebLinkAboutDoroski, Robin 1,, ��FFOIKCOGy
JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK p T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS Irb Southold, New York 11971
MARRIAGE OFFICER �Q - Fax (516) 765-1823
� �1D O. 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. 981 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ROBIN DOROSKI
Address 1 : P. O. BOX 520
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
REPLACE EXISTING BLOCK CESSPOOL.
APPROVED AS SUBMITTED. EXCAVATION INSPECTION REQUIRED. CALL
765-1802 FOR NECESSARY INSPECTION
Name Of Owner DOROSKI, ROBIN
Mailing Address 1 P. O. BOX 520
City St Zip MATTITUCK NY 11952
Property Address 1 NEW SUFFOLK AVNEUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 3 lot 25.005
Cross Street AIRWAY DRIVE
Building Permit Number Cross Reference:
Issue Date: 4/23/93 Judith T. Terry
Southold Town Clerk
LCOWN._ SEAL]
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JUDITH T. TERRY ;,b Town Hall, 53095 Main Road
TOWN CLERK : O P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS VS Southold, New York 11971
�0 �. ° Fax (516) 765-1823
1;p('4.—e. (— *1 =.'`0 4. ��4 0�� Fax
(516) 765-1801
i �,e j
t, ' ISR I 51993
1` I OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: April 14, 1993
Transmitted herewith is a copy of application No. A1007 for an •
ALTERATION PERMIT for a cesspool or septic system submitted by
Robin Doroski ,
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 - 'D(
DISAPPROVE -
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AQ► . Signature
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Date
v
OFFICE OF THE TOWN CLERK """
Town of Southold
Town Clerk Application No. /00 7
Judith T. Terry, �w`
Town Hall, 53095 Main Road = Construction
P. O. Box 1179 y Alteration
Southold, New York 11971 t
$10.00 - Residential
Telephone � ����,�
(516) 765-1801 1 s 0 $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 T.7(`-i 7(u
t
APPLICANT NAME: RO Dc)(-1,-() /1C1\ MOW 6ticGk
APPLICANT ADDRESS: ��✓ iIC qv 2 - ort S^ 0
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONS RUCT ION16/(-0 ,51c-(..
R ALTERATION:
OWNER OF PROPERTY: VOL' \ O&n s/c(..
OWNER MAILING ADDRESS: -CR.A1¢
OWNER PROPERTY ADDRESS: cs
TELEPHONE NUMBER OF CONTACT PERSON: 165 C(g yl
TAX MAP NO. : Section / Block 3 Lot 2.5 f
CROSS STREET: Af-0--(A)cP(2-<<- A
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of pplicant
RECEIVED BY: imminimi .
erk's Office
DATE: •APR 1 4 1 .5
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