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ELIZABETH A. NEVILLE /11= 4 ; Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
W t Southold, New York 11971
MARRIAGE OFFICER : ,fiL � ���� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER "1101 �4,ill Fax
(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. 2367 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : STANLEY SKREZEC
Address 1 : 50 GULL POND LANE
City St Zip GREENPORT NY 11944
Descripton of Proposed Construction or Alteration
REPLACE EXISTING METAL SEPTIC TANK WITH NEW PRE-CAST CESSPOOL
APPLICATION APPROVED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner MANN, DAVID
Mailing Address 1 22 MIDDLETON ROAD
City St Zip GREENPORT NY 11944
Property Address 1 22 MIDDLETON ROAD
City St Zip GREENPORT NY 11944
Tax Map No. section 40.00 block 5 lot 24.000
Cross Street WASHINGTON AVENUE
i3uilding Permit Number Cross Reference:
Issue Date: 7/17/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE Town Hall, 53095 Main Road� �
TOWN CLERK o P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS
�y. � Southold, New York 11971
MARRIAGE OFFICER �,L $ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `� '/Ol �►al/ Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: July 13, 2000
Transmitted herewith is a copy of application No. 2455 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Stanley F. Skrezec for David Mann
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you. ( �
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - ✓J
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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Date
OFFICE OF THE TOWN CLERIC �"" t' %UL4
TOWN OF SOUTHOLD •'•O ` M QG=
% Application No."-2SLS 3
ELIZABETH A.NEVI LE,TOWN CLERK J► �
P.O.BOX 1179 ' Construction
SOUTHOLD,NEW YORK 11971 Z ; K
• in Alteration
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Telephone ‘0000,
$10.00 -Residential >c,
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(631) 765-1800 -.1 411�,,�• $25. 00 -Non-Residential
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TOWN
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. •
Fee .$
DATE 7/1 5 /ot)
APPLICANT NAME:
APPLICANT ADDRESS: (ot.V t__ Let-Veg-•
SEPTIC CESSPOOL X
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION �^1
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Dk-1,11i ^ IJ
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: p•9 ( ' ,� Q� �
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TELEPHONE NUMBER OF CONTACT PERSON: `} "A-1 \ 2Z
TAX MAP NO. : Section ' 4,O Block Lot �,
CROSS STREET: .
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signat re of Appl an
RECEIVED BY:
Town Clerk's Office
DATE:
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