HomeMy WebLinkAboutCichanowicz, Neal '//
•
4' ��
ELIZABETH A.NEVILLE • o•1 �� Town Hall, 53095 Main Road
TOWN CLERK y •Z P.O. Box 1179
*'�� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS y�L C Fax(516) 765-1823
MARRIAGE OFFICER ---
RECORDS MANAGEMENT OFFICER �� Telephone (516) 765-1800
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. 1922 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : CICHANOWICZ, NEAL S.
Address 1 : PO BOX 1285
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWEILLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-98-0122
Name Of Owner CICHANOWICZ, NEAL S.
Mailing Address 1 PO BOX 1285
City St Zip CUTCHOGUE NY 11935
Property Address 1 INDIAN NECK LANE
City St Zip PECONIC NY 11958
Tax Map No. section 86.00 block 4 lot 6.004
Cross Street LESLIE ROAD
Building Permit Number Cross Reference:
Issue Date: 8/27/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
,O��S�FFO�,�c / f Z
ELIZABETH A.NEVILLE tt h`Z`• Gym; Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
t ti 2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �'�� Fax(516) 765-1823
MARRIAGE OFFICER � y Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER Ql �I
FREEDOM OF INFORMATION OFFICER '0,8
�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 25, 1998
Transmitted herewith is a copy of application No. 1999 for a Cesspool/
Septic Tank Construction Permit submitted by:
Neal J. Cichanowicz
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:
-
Signa 111-
g LI-6 /11V
Dated
,,,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD ,,s CSG Application No. /99?
FT J7ABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 ft Construction
SOUTHOLD,NEW YORK 11971 Alteration
Telephone y°i� �Q�i� $10.00 -Residential
(516) 765-1801 "=y41 11�;,.',�� $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 ti/fg
APPLICANT NAME: Neal -57
-+CL+ano��cq
APPLICANT ADDRESS: ?0 ec IZ.2
SEPTIC X CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Pk>' - frt. eo.sed re-L-1 c,Qv...s4,.►(AFo►-.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: N ea.I '3.
Ci Lko o�i L
OWNER MAILING ADDRESS: P3 t ox Cass
OWNER PROPERTY ADDRESS: .1viehcar tOeJz
'Pc�or.:c
TELEPHONE NUMBER OF CONTACT PERSON: 771 -56'V 73y -5y/ 2
TAX MAP NO. : Section $(p Block 17' Lot (o,y
CROSS STREET: LeOic. RcO.
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signatubf Applicant
1
RECEIVED BY: )
Tow 517r Office
� �DATE: ,�
•
•
SURVEY oF LOT # 4 0 l 1.
MAP OF "WILD OATS" c �\ Rood •
FILED WITH THE GOUNTY GLERK °°;
• �60� Ang1e '
ON MARGH t, 11'I3 AS FILE #j331 a
SITUATE: PEGONIG o 5�
°° k.31 Test Hole Data
TOWN OF SOUTHOLD ��°
ego \ 9 ` (not to scale)
SUFFOLK GOUNTY, NY LOT # 3 ° °
Topsoil
ePJ`,cr -------\ ei. 0.3'
e
el_�03\ 5'41'•, Dat
SURVEYED 8-8-q8 `',11,,--.._— , �{ gown
SUFFOLK GOUNTY TAX # „e\250----.0°'
2f�.O°1 saw
1'110 �1 i.3'
1000 - 86 - 4 - 6.4 I 1
�� Medium
. '46f814 Brown
l'' .$;:,
CERTIFIED TO: e t'a52,�;F "' 3.5' Sand
NEAL G I GHA Z _ I ' TfC o ModWm
W VV N� Sand
gtl`�`�0•
loaa L L 10 CV v 11 f� �j/ and
• �eMa>�a�1d • / -PC. i./i' ✓`� gavel
•
�66� ti`a9
L
�^ ✓ ��` t LOT #4
AO 02)
P (J� 1. N O Sand
• O, •, j�/ �� / O and t.
1TJ [ 1 444___ ' ,
1 \ 4 ?.......20
� ' \1/4\
0 ® 9g
l /
4-410404
°y
CI-1 Q °�' +C� 17.0_ a
O
o '1'�O"� 2 0
O�
2 _ICS 51D (—,
....._/ .—�
•
pipe Sl
1.401vi
#5
SUFFOLK CO DEPARTMENT OF HEALTH SERVICES
,, 'unauthorized alteration oraddition to a survey
sap bearing a licensee land surveyor's sealr tha
e
violation of section 7209. Sub-tlivssson 2. o
OF CONSTRUCTION FORA SOF NEW t O New York State Equcation La«.'
NOTES: PERMIT FOR PROVAL �� r only coeiea fro.the originu er rola aur.ay
57i1�GL FAM marked with an original of the o be surveyors
■ // Y ItESIDEioTCE ONLY � �kQ�C ,AG•E 'i,,- stamped,eel snail be considered to be y.11tl tr«e
MONUMENT FOUND DATE W 2 l ql HS REF.NO.Rio 90 ' DI�� �aelea
...?1 ► } •cerufScauon,lnelcautl nereon slgniey roar tots
k,...1‘, 1 survey wsa oreoeree Sn accortlance vers the
0 ww�/�' ' 0 ' �•. n '• ..y flof:!:::ff;f:tihlet:71::::::::::::
ateasaoc tat ionf ProftsafonivPIPE FOUND APPROVED iattics rayantl surveyswna,tetl
�. • 1 LSoSao cert lr icer lonsoebll r only1'� _"` '' I� tn orwoos the survey Sa oreoeree.•h ' ,� Seo Ma tttie[listed. anSon..en-
e'' afi
ta]agency ano lentllnq in,titutlgn lfg:n. nereon, antl
FOR MAXIMUM OF eN % A. to the assignees or the lemm�q insututian. Certir
BEDROOMS ,Q:' sloes are not transreragle to additional smtttut ions
EXPIRES THREE YEARS FROM DATE OF APPROVAL '��� \fir, AND. . ��
�� "V' �LAND
d N I�\:.\\'-
N.Y.S. LIC. NO. 50202
GRAPHIC SCALE Irv= 40r ` JOHN C. ' 'S LAND SURVEYOR
�/ + • 6 EAST MAIN STREET
RIVERHEAD, N.Y. 11901
• 369-8288 Fax 369-8287 REFERENCE # 98-0214
•