HomeMy WebLinkAboutSurozenski, David ,o��g�FFO(,�c
ELIZABETH A. NEVILLE �� OG'y� Town Hall, 53095 Main Road
TOWN CLERK y - P.O. Box 1179
v, Southold, New York 11971
REGISTRAR OF VITAL STATISTICS . Q Fax(631) 765-6145
MARRIAGE OFFICER *" y,L ��
RECORDS MANAGEMENT OFFICER "'/�l %/4 00°� Telephone (631) 765 1800
FREEDOM OF INFORMATION OFFICER _ .*i
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2320 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL
Address 1 : 2760 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
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 SUROZENSKI, DAVID
Mailing Address 1 39765 COUNTY ROAD 48
City St Zip SOUTHOLD NY 11971
Property Address 1 39765 COUNTY ROAD 48
City St Zip SOUTHOLD NY 11971
Tax Map No. section 59.00 block 9 lot 30.001
Cross Street KENNY ROAD
Building Permit Number Cross Reference:
Issue Date: 5/16/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
a3P-13
0000,
411 FOUI.
ELIZABETH A. NEVILLE I= y� Town Hall, 53095 Main Road
TOWN CLERK co P.O. Box 1179
� h Z
�y, n� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Q Fax (631) 765-6145
MARRIAGE OFFICER y
RECORDS MANAGEMENT OFFICER �_� �1
Ql ��0 0. 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: May 16, 2000
Transmitted herewith is a copy of application No. 2408 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
David Surezenski by Morris Cesspool
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 -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
SignaL.&//ef/ehOP
t
Date
OFFICE OF THE TOWN CO
TOWN OFSOUTHOL ; OUrApplication ,i(()tir
BIZZABETH A.NBVIIIE,TOWN CLERK ;• .
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971
Alteration
Telephone
$10.00 -Residential
(631) 765-1800 " l ���
$25.00 -Non-Residential
TOWN OF SOUTHOLD.
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. •
Fee .$
DATE ('211/ 0-6
APPLICANT NAME: / ;/I/
APPLICANT ADDRESS: 2 ?c 'c 1
51.O - - y
SEPTIC CESSPOOL,4
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
6-'0-C,c/idtc7
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR, ALT AT ION:
• OWNER OF PROPERTY: , dat.2
6fOWNOWNER MAILING ADDRESS: 29 765-
OWNER
ER PROPERTY ADDRESS:
•
TELEPHONE NUMBER OF CONTACT PERSON: 7ir Y7dr_.)
TAX MAP NO. : Section ,9"- ? Block Lot _?•
CROSS STREET: /Q 2
BUILDING PERMIT NUMBER CROSS REFERENCE:
ignature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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