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HomeMy WebLinkAboutKrupski, Raymond �E OF THE TOWN CLERK Town of Southold ���� ��OG ,th T. Terry, Town Clerk Z 4` wn Hall, 53095 Main Road P. O. Box 1179 . Ln Southold, New York 11971 O` �0�. ��� Telephone �( * '� „ (516) 765-1801 ' TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 330 Residential X Fee $ 10.00 Non-Residential Septic Cesspool X PERMIT ISSUED TO: NAME: Raymond Krupski and Cecelia Krupski ADDRESS: P.O. Box 1772 Southold, New York 11971 DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION New Single Family Dwelling with Cesspool System. APPROVED as submitted and as approved Suffolk County Health Department. LOCATION OF PROPOSED CONSTRUCTION or ALTERATION: OWNER OF PROPERTY: Raymond Krupski OWNER MAILING ADDRESS: P.O. Box 1772 Southold, New York 11971 OWNER PROPERTY ADDRESS : Grissom Lane Southold, New York 11971 TAX MAP NO. : Section 78 Block 1 Lot 10.5 CROSS STREET: Sleepy Hollow Lane BUILDING PERMIT NUMBER CROSS REFERENCE: Judith T. T y Southold Town Clerk DATE : May 5, 1988 (TOWN SEAL) a . 111111� -.1� rr • R29 � r BLDC.DEPT. r%' t 0 . • •LEI %n .i 4'+.--:->:.' '"' Town Hall, 53095 Main Road ,7", -7,%fir P.O. Box 728 ', Southold, New York 11971 JUDITH T.TERRY TELEPHONE TOwv CLERK \ (516) 765-1801 REGISTRAR OF VITAL sTATISTIQS'� 3/' ) OFFICE OF THE TOWN CLERK v(l TOWN OF SOUTHOLD April 29, 1988 To: Victor Lessard, Southold Town Building Department From: Judith T. Terry, Southold Town Clerk Transmitted herewith is a copy of application No. 334 for a CONSTRUCTION or ALTERATION Permit for a cesspool or septic system submitted by Raymond & Cecelia Krupski Please review the application and location map and advise if the project has received Suffolk County Health Department approval and if we may issue the permit. Please complete the form below and return it to my office. Thank you. dreitar4• Judith T. Terry Southold Town Clerk * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendation: APPROVE - p( _ DISAPPROVE - COMMENTS: (1,„ I £;e t_ b , t t0g.- Z,ILAJUL;g21 '14 CiglAh041 \+L-•‘ 1.4. 49.1G ei) , '41•RALSLIC $131• \(:: -°-‘ dr22a-ILAn==.- , Signature 41a.9 1-2y Date •S .,,, OFFICE OF THE TOWN CLERK C. FOU( Town of Southold Application N �� Judith T. Terry, Town Clerk �. . o. 7 Town Hall, 53095 Main Road ac Construction P. 0. Box 1179 Southold, New York 11971 ,y, •`, Alteration Telephone 0l 1 t y►�� •• Residential (516) 765-1801 Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICAT ION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ /D DATE OiriX\ \ \ ca APPLICANT NAME: �Ac(\E °� (-)? CiAl (i. )Kir o ;,SK( APPLICANT ADDRESS: Q(o SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION N1,0lt\SIAQ... k.A A to 011\Q LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPGSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: VO,LINLDI\O (upsYk OWNER MAILING ADDRESS: Qu CDOIC M Z- OWNER PROPERTY ADDRESS: Q(\c j fv\ L czQ Vv SOUkkOd TELEPHONE NUMBER OF CONTACT PERSON: -7 (p C SAO kr TAX MAP NO. : Section 7 b Block / Lot /U , CROSS STREET: L€&Py SIU //v ,Ln, BUILDING PERMIT NUMBER CROSS REFERENCE: it • CaLL-a-- J Signature of ppli nt RECEIVED BY: C t ilf n CI k's4f1?-(--- DATE: /a -wimp APR 2 91988 lawn Clerk Southold . 1 4 ....11;1010. , . SUFFOLK CO. HEALTH DEPT. APPROVAL . _ . • ; . • H.S. NO. • ' . , .,. ' • - - , ., Er-' 7,00 ' • • t..V., ps . ,. \ , . 1.:4-,R,6 F,:-.. • k. itikleel " 1 4°IV Cr T *2 * 1"j44Y' ' . - 1 li g' fa, . , ats. F . 1-1101/AL -•• . .. . • . ,,•-• rt Vvi 4 • '4 ' - STATEMENT OF INTENT , V;, • ileb• . THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE ,„ WILL1, , . , -, ' ',, • , -:':. . .: m"iR .25 1988 .„ . , CONFORM TO THE STANDARDS .:OF THE .' • , , . . . i. '.- . . .. - : ' ' '• - .• - ' , SUFFOLK ç9. DEPT. OF EALAriq SERVICES, 1.- c DEFT. IN , . (5)4 1 A . i APPLICANT . , . '' 4. ' •,!..i.'" ' '. A1.1 ..._ , , '''''•2:•..''. '.'''' ',. ' j:' s ' ` ' SUFFOLK, , COUNTY DEPT. OF HEALTH , . .. SERVICES --- FOR APPROVAL -, OF . . „ CONSTRUCTION ONLY . . . -AP faec- ir:i4:20,c'E'Rr)...." . - . - . , . - DATE. ),--,e-c, ' H. S. REF. NO.: 6- ' • .. `,.,- - ' ...4 ..., - APPROVED: r, /S/0. .-:/* * CELIA B aiPS*t \5(t<fit - ell Ar - \ SUFFOLK CO. TAX MAP DESIGNATION: • ; . bIST. ' •SECT,:4., BLOCK . PCL. . / Lo a 7-.7„41e4P N -,r 0 0 0 - , , • OWNERS ADDRESS: - ,.. . • \ , • 5.18a,4?-444,440-tev4-444,w_if(5)50)0).7' ., ..•„ . . / . - ..... , • • 504./ittscied, tki:Y. 11971 S CA t ele ' \`5'4° '1; I • • . ,Al. e(. 766-561,5' . . - . • z plAis : - . . . ‘ • . . ... , DEED: L.t4/(44 P. , . . . TEST HOLt T 'C.-A"-40r/74.1 atteretion or acki.tiort ' STAMP . tr, ' r 541y-4,T tp a violation of . . - e a 4-0,. ..-ictio 5.1 aez re feel .' 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