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ELIZABETH A. NEVILLEGyd; Town Hall, 53095 Main Road
TOWN CLERK H - P.O. Box 1179
,�$ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (631) 765-6145
MARRIAGE OFFICER :� ��il.
RECORDS MANAGEMENT OFFICER � "'/Q! 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. 2365 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : STANLEY F SKREZEC
Address 1 : 50 GULL POND LANE
City St Zip GREENPORT NY 11944
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 FROST, TIMOTHY
Mailing Address 1 233 EAST 69TH STREET
APT 14-0
City St Zip NEW YORK NY 10021
Property Address 1 2190 VILLAGE LANE
City St Zip ORIENT NY 11957
Tax Map No. section 26.00 block 1 lot 1 .001
Cross Street KING STREET
Building Permit Number Cross Reference:
Issue Date: 7/12/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE i� y�; Town Hall, 53095 Main Road
TOWN CLERK o
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ,i Southold, New York 11971
MARRIAGE OFFICER Fax Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER '_y'*O , ,i► Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICERili
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 10, 2000
Transmitted herewith is a copy of application No. 2453 for a Cesspool/Septic Tank Construction
Permit submitted by:
•f4
Stanley Skrezec for Timothy Frost
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 loca ' n map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
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Dated
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ELIZABETH A. NEVILLE �� 'yd; Town Hall, 53095 Main Road
TOWN CLERK C P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v. i Southold, New York 11971
MARRIAGE OFFICER ` 1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Fax
Alp �� i��, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ ,���
'�. , ..�i
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 10, 2000
Transmitted herewith is a copy of application No. 2453 for a Cesspool/Septic Tank Construction
Permit submitted by:
Stanley Skrezec for Timothy Frost
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:
Signature
Dated
t OF THE TOWN CLERK ,,,'",,,,
Town of Southold .0114F�IKt+. 21i�L�
Judith T. Terry, Town Clerk /y , Application No. 'Ycc��
Town Hall, 53095 Main Road ;L; Constructions
P. 0. Box 1179 o T,
Alteration
Southold, New York 11971 ct�
Telephone ,f 41-/ $10.00 - Residential
(516) 765-1801 Ol 4$,' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION RECEIVED
for JUL 1 4 200
CONSTRUCTION or ALTERATION PERMIT Iwamoto Town Clerk
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE �L lob 2-c9t=7=
APPLICANT NAME: ' Ler( Wre2-e
APPLICANT ADDRESS:
SEPTIC CESSPOOL eK
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION r+`kVt.N.1 �J
OL4 `c- C s:>•?)(. t. - 2 I x S ` >Q
e&s s- pre c 4 .T, 'cs-4s r (S12-..., 'h9,Q a-,r,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: '''fvIv`v�(/L —t`c. t Iy-0
OWNER MAILING ADDRESS: ` -{ .i` c)1-5j £o-4 6 9 Sf
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YMY I CXY ..1
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OWNER PROPERTY ADDRESS: p9-.Val U V �& ( 45-- L4s..
9r- / xi -Y. ll 1 .5 "7
TELEPHONE NUMBER OF CONTACT PERSON: �� _ L e
TAX MAP NO. : Section 2\(.9 Block Lot \ . '
CROSS STREET: ^ (.9 STr-e-e-
BUILDING PERMIT NUMBER CROSS REFERENCE:
Si n to of Applicant
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RECEIVED BY
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Town Clerk's Office
DATE: I (j
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