HomeMy WebLinkAboutStrong, Dolores oft'' VFFO( =
ELIZABETH A. NEVILLE ��_ # Town Hall, 53095 Main Road
TOWN CLERK ; H P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 1? Fax (631) 765-6145
MARRIAGE OFFICER
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RECORDS MANAGEMENT OFFICER � *0 sea 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. 2292 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : WENDY AND EUGENE PACHOLK
Address 1 : 618 CARPENTER STREET
City St Zip GREENPORT NY 11944
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-99-0235
Name Of Owner STRONG, DOLORES
Mailing Address 1 PO BOX 1033
City St Zip MATTITUCK NY 11952
Property Address 1 950 LEGION AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 142.00 block 2 lot 15.000
Cross Street PACIFIC STREET
Building Permit Number Cross Reference:
Issue Date: 4/14/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE /�0o011 yTown Hall, 53095 Main Road
d:
TOWN CLERK o - P.O. Box 1179
% yZ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS $
MARRIAGE OFFICER Fax (631) 765 6145
`
RECORDS MANAGEMENT OFFICER =y-491 +.00 Telephone (631) 765 1800
FREEDOM OF INFORMATION OFFICER - �
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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: April 7, 2000
Transmitted herewith is a copy of application No. 2380 for a Cesspool/
Septic Tank Construction Permit submitted by:
Wendy & Eugene Pacholk .
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 i/
DISAPPROVE
Comments:
ignature
41, /0
Dated
4
4.
OFFICE OF THE TOWN CLERK ,''•St f i`k
TOWN OF SOUTHOLD •••' �l QQ Application No.Z 3 3rd
ELIZABETH A.NEVILLE,TOWN CLERK •
P.O.BOX 1179 ; _ ttx ConstructionFi
SOUPHOLD,NEW YORK 11971v Alteration A
Telephone
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$10.00 - Residential
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(516) 765-1801 -_' 4t$,,0 $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 4o ' ' DOD
APPLICANT NAME: ,}6,44 f- .2t---4.1-6._- f 2 /C
APPLICANT ADDRESS: a/17 ( I4 ,4 6'7?fc 6=t'
(�O,C ; /(/ //9 `[/
SEPTIC CESSPOOL ,
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION Nee.6.> ?L
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION/ 10.
OWNER OF PROPERTY: (0 t &�- r oc
l/f C,,
ADDRESS: �T�- j%,QL��% t
OWNER MAILING
OWNER PROPERTY ADDRESS: 4'5Zl°perG`Wt-e -
c, r%"/7.e e1 /9-2-
TELEPHONE NUMBER OF CONTACT PERSON: 43/ t/7-7--/c _.5
TAX MAP NO. : Section / '5V--- Block 0 - Lot /
CROSS STREET: a,ifile: p� 30,1-) t 4'1,. iC
BUILDING PERMIT NUMBER CROSS REFERENCE:
/(z-7-------
/ Si ature of Applicant
RECEIVED BY : fes , 2—
T wn Clerk's Office
DATE: / 7. O6
Are,- sl�, � RECEIVED,
SUFFOLK COUc�TY
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SURVEY FOR
17Wale,.n SW VP �d EUGENE A. & WEND Y L. PA CHOLK
The locations of wells and cesspools AT MA TTITUCK
shown hereon ore Irom field observolions TOWN OF SOUTHOLD
and or from data oblau;ed from others. SUFFOLK COUNTY, NY.
1000- 142- 02- 15
I am familiar with the STANDARDS FOR APPROVAL SCale: I = 20'
•
AND CONSTRUCTION OF SUBSURFACE SEWAGE Oct. 25,1999
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
and will abide by the conditions set forth therein and on the -
permit to construct. '
ELEVATIONS ARE REFERENCED
TO AN ASSUMED DATUM. �Q.kt Of
NEW O
Y
ANY ALTERATION OR TO TNS SURVEY IS A VIOLATION c� N T.MFt �P
OF SECTION 7209
PER OF DK AlEir YORK STATE now LAD. T �O`' r zo f
HMEON...ARE SAP aur OR THE VALID OR oNs /., f40).":•' * .S. LIE. NO. 496/8
OTIOSE SMAGI alt %:J itiffiSkii
p� LY TO C LY 4TTN LAO TI+uNLarTETIE0Yar ��.'�.M P'ee,�3" YO , P.0T- a ' A"° l °Po 0
SOU• J, 11971
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. 05-309