HomeMy WebLinkAboutWoloski, George •••+NI eteG •
ELIZABETH A.NEVILLE � 'y ; Town Hall, 53095 Main Road
TOWN CLERKy - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS , Southold, New York 11971
ARRIAGE OFFICER :� 1- Fax (631) 765 6145
M
RECORDS MANAGEMENT OFFICER 0.1 �$ �i' Telephone (631) 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. 2358 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : PO BOX 972
C;ty St Zi MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF OVERFLOW TO EXISTING SYSTEM.
APPLICATION APPROVED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner WALOSKI, DANIEL H
Mailing Address 1 PO BOX 198
City St Zile MATTITUCK NY 11952
Property Address 1 280 YOUNGS AVENUE
City Sl. Zif. MATTITUCK NY 11952
Tax Map F;D. section 141 .00 block 1 lot 31 .000
Cross Stri_;'l.
13ui.dir,g Permit Number Cross Reference:
Issue Dat( . 7/07/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE �t'= Gt.A‘ Town Hall, 53095 Main Road
TOWN CLERK ` y- , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % v' Southold, New York 11971
MARRIAGE OFFICER G �, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `;y"�/�l ����i��1 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER .--4'--......'"
_,I ..'���I'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 28, 2000
Transmitted herewith is a copy of application No. 2446 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Waleski
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings, property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
ignature c\6-
(, /3 otoo
Dated
OFFICE OF THE TOWN CLERK 1""' �FF DLK
TOWN OF SOUTHOLD ,' `'CQ ' Application No.'o y14A
FTJ7ABETH A.NEVILLE,TOWN CLERK • �.O 'G�►
P.O.BOX 1179 : 1O Construction
SOUTHOLD,NEW YORK 11971 Z
Alteration
Telephone 0,� 00: • $10.00 - Residential
(631) 765-1800 = 1 �;,"'0 $25.00 -Non-Residential
>•'
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
RECEIVED
for
CONSTRUCTION or ALTERATION PERMIT JUN 2 8 MOO
SEPTIC TANK or CESSPOOL aouthoici Town Clerk
Permit No.
Fee '$
DATE6/2,-Ve
APPLICANT NAME:
APPLICANT ADDRESS: Ad /5-0-y q 7L
n4-77:/tv /v" /#
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
�' �L�fi�%r./�► AJ-/.4.,t/
-
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: p ni hj,1/ 5I
OWNER MAILING ADDRESS: 2 % • �iu�' ,44 f)y / /q
OWNER PROPERTY ADDRESS: ..�' ��
asr,
TELEPHONE NUMBER OF CONTACT PERSON:— 16 $ 7"
TAX MAP NO. : Section / LH Block / Lot 3 /
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of plicant
RECEIVED BY
Tow Clerk's Office
DATE: � 06
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