HomeMy WebLinkAboutKujawski, John sifficOf
•
JUDITH T. TERRY ' • : Town Hall, 53095 Main Road
TOWN CLERK =G T ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS . . Southold, New York 11971
MARRIAGE OFFICER '�` Fax (516) 765-1823
_7`Ol 10.,01$/ Telephone (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. 775 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JOHN P. KUJAWSKI
Address 1 : P. O. BOX 598
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 10/22/91 .
Name Of Owner KUJAWSKI, JOHN P.
Mailing Address 1 P. O. BOX 598
City St Zip CUTCHOGUE NY 11935
Property Address 1 ORIOLE DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 55.00 block 6 lot 15.001
Cross Street TUTHILL ROAD EXTENSION
Building Permit Number Cross Reference:
Issue Date: 11/12/91 Judith T. Terry
Southold Town Clerk
(TOWN SFAI
1 i
�,,��'��FFOLK�" _ ?.Ai OCT 3 01901
JUDITH T. TERRY ; Z •L : �LD�'' �1, 53145 Main Road
TOWN CLERK ; =v .4-712 ; TD\�Jw OF ;ex 1179
REGISTRAR OF VITAL STATISTICS Cl'� Southold, New York 11971
MARRIAGE OFFICER yV r ° Fax (516) 765-1823
4 ��0 ���
= Telephone (516) 765-1801
1 * �'
_—. ,,
., ,,,,,.°�,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Southold Town Code Enforcement Officer
From: Linda Cooper, Southold Town Clerk's Office
Dated: October 30, 1991
Transmitted herewith is a copy of application No. 796 for a Cesspool/
Septic Tank Construction Permit submitted by:
John P. Kujawski .
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.
4
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE X
DISAPPROVE � l, n
Comments: 4. h j. y .kftoI 41...,, O tacit, y�SL, C.412A1
%4AMAL4A
44 OltirbiALA 61 Ok+�.^I`� Ale Co. i s thr. ti .
{l1p
t?NA IG/ 2-2-14/
RECEIVED ti 0.4- CYCA.24 _' J
Signature
r O;I f , lgc11 „14/ 9 t
Dated
Tow Clerk Southold
4
OFFICE OF THE TOWN CLERK Ocj\\FFU(,r`,'
Town of Southold �. ,;r Oj
Judith T. Terry, Town Clerk Application No7 G
Town Hall, 53095 Main Road -=1 t1' 4 . - Construction
P. O. Box 1179
•
Southold, New York 11971crs Alteration
Telephone "01 r a NP6' Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
RECEIVED APPLICATION
OCT 901991 for
Tc�mciediSOuthOd CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $1O
DATE Q \_-' 0\C\I
APPLICANT NAME: „\p h) P \� iAvJS�Z
APPLICANT ADDRESS:
SEPTIC CESSPOOL----
DESCRIPTION
ESSPOOL/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: J ) Q KSkr
OWNER MAILING ADDRESS: P-0-41 "-
Cv -V\C uQ. \)
OWNER PROPERTY ADDRESS: Dc��-
TELEPHONE NUMBER OF CONTACT PERSON: --)ENS
TAX MAP NO. : Section SS" Block Lot � /o Is
1r ) 41\1\\
_ CROSS STREET: 1 \1\ (Z
\ ,Q . �te, t[Yt(� 1
BUILDING PERMIT NUMBER CROSS REFERENCE:_.
C;2
Signature o plicant
RECEIVED BY: ,,
ow ( Clerk's Office
DATE: /0/...4.47/9/
.i i~~
v
li)\/1
C
- _
IVACANT l I 1 .
-
�w=TER=AIN— •-1EL`20
— --- - DRIVE
EL22.9 ORIOLE I Q
107.17 R; \ D
N.8203420"E EL.n.l `0
I ``s9 00- I
EL-23.0
_l 11A es.
v p01�pRD LP 1 ig r I 4
S54'-' � 5_0 II ^' \ INr
Z r
*1 0 0
0 y c
N 8'd rr�t11
01 meojf.—
$_ _ 42 —— --\-7,'veO''°'Lr+ s v+T`tER 'c't rag
� �
— `AT 1 C �•S.
O A� I I... 1 p �''n.
° ¢ / ` ; V
Novo,LV vRGpp7EV 111 I i
I.oko to R,JLv4P,
L O%22 vQoo . o
(VACANT) vp„c AI YI _ _i . I.,'
1
tI y 'W Q_ t 1 E .214
' w 2\\415 5. • 1EL.z2.
\60.00 ` 4
VIr
EL:230 S.t40342o,W r
i
0
O S
IV P
/i
I sly �ICSify
GLE FAMILY
Ex (RES TV'10 YEA �WELLiNG ONLY z�
RS FROM DATE OFAPPRO':',',L. so so T
CFS _ •
SURVEY FOR
JOHN P. KUJAWSKI
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES LOT NO.2I, 'HI(iHPOINT MEADOWS,SECTION TWO
AT SOUTHOLD SEPT2 ,1991
DATE. 5
SEPT. 5,1990
FORT APPROVAL
Of CONSTRUCTION ONLY TOWN OF SOUTHOLD SCALE I 40'
_�j'E L L- e— !3 C.A SUFFOLK COUNTY, NEW YORK NO 90 0659
)4SREF. NO.
GATE •umurNORUIo low OR*DOIT,oN TO THIS GUARANTEE P
f i SURVEY 4• v10LAT10N OF SECTION 7209 OF THE JOHN P )cIAAYSKI
7 , 7p l (. L:' t rNEM YONA STATE EDUCATION LAW
v(.4.:,,-
..COPIES OF THIS SURVEY NOT MIARNA THE LAND TICO' y'�►T� -GUARANTEE
A�onV� ` . ' \
�, lt,ilO. _iY -5 ',/o� SUNYNrOR sE' mkt() SIAL OR[MAOS!50 SEAL SHALL p D Yy
NOT ICONSIDEREO TO SE A vALIO TRUE COPY
N GUARAMT([! INDICATED MINION SHALL RVN ONLY TO O� `OG
VAT
1 HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUE T THE PERSON FOR WHOM THE SINE. IS PREPARED 4 t ,
ANO CH NIS BEHALF TO THE TITLE COMMNY,GOVIAN- ID
R NEAREST WATER SAIN_MPN
I _ �*SOURCE OF WATER INTE_PUBLIC MENTAL AGENCY AND LENDING INSTITUTION LISTED
II SUFI ����
SF CO.TAX P DHT 1000 SECTION 5BLOCK.L LOT 52215.1 HEREON, yyA
AND TO THE ASSIGNEES OF THE LENDING , 1 4a J
R TIER[ ARE ID OWELLINS1 WITHIN 100 FEET OF TIPS PROPERTY INSTITUTION GUARANTEES ARE NOT TEN. BLE
OTHER THAN THOSE SHOWN HEREON TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT
S THE WATER SUPPLY AND SEPIAS(DISPOSAL SYSTEM FOR THIS ROIDENQ OWNERS 1T0
WILL CORFORM TO TME STANDARDS OF THE SUFFOLK COUNTY DCPARTM(MT
*DISTANCES SHOWN HEREON FROM PROPERTY LINES 1`r.. j
TOCIISTINS STRUCTURE! ARE FOR A SPECIFIC Lr' P �/
OF MEAL TN SOMIC,LS IVR►03[ AMO ARE NOT TO B[USED TO 1!H �O 0/O. a
APPLICANT ///T�/�a� /_ �i PROPERTY LINES OR FOR THE ERECTION OF FENCES SND S
AOOIIESSDJ. �Y 7S7 �0.F3 i('_�777/'J(�-Mrs. .. f
Sv(,rf1te•its, A/64+ r( TIL 777— 1rioa YOUNG a YOUNG 440EAST NOEAVENUE
NOTE I0=STAKE O. PIPE
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF ALDEN W YOUNG,PROFESSIONAL ENGINEER
SUFFOLK COUNTY ON MAR.19,1990 AS FILE NO.8911. AND LAND SURVEYOR N Y.S LICENSE NO 12845
HOWARD W YOUNG, LAND SURVEYOR
e *TIM LOCATION OF WS.LIWI,SEPTIC TANNISTNI CESSPOOLS( ')SOWN'SPECS NYS LICENSE NO 45893
ME NEON FIELD OSSERMTIONS AND ON DATA OBTAINED FNON OTHERS
[B.
BRANDIS A SONS INC.