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HomeMy WebLinkAboutDoroski, Gerald co , G ELIZABETH A. NEVILLE I,l`Z`)- y�; Town Hall, 53095 Main Road TOWN CLERK p :4P.O. Box 1179 ti = Southold, New York 11971 REGISTRAR OF VITAL STATISTICS v. t MARRIAGE OFFICER % 1 Fax(516) 765-6145 `. RECORDS MANAGEMENT OFFICER t* a04' Telephone (516) 765-1800 FREEDOM OF INFORMATION OFFICER : .l I* '�pid OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 2177 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : MELANIE DOROSKI Address 1 : 210 BROAD STREET City St Zip CREENPORT 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 #R10-99-0169 Name Of Owner DOROSKI, GERALD M. AND MELANIE Mailing Address 1 210 BROAD STREET City St Zip CREENPORT NY 11944 Property Address 1 65 AUGUST LANE City St Zip GREENPORT NY 11944 Tax Map No. section 53.00 block 4 lot 44.013 Cross Street KERWIN BLVD. Building Permit Number Cross Reference: Issue Date: 10/22/99 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) • OOFFOL,�c . OZ, ( 1 1 ELIZABETH A.NEVILLE _`Z`� �y�,; Town Hall, 53095 Main Road TOWN CLERK ; o - P.O. Box 1179 REGISTRAR OF VITAL STATISTICS #3 t Southold, New York 11971 uso MARRIAGE OFFICER 1Fax(516) 765-6145 RECORDS MANAGEMENT OFFICER `; v4 O� �� Telephone (516) 765-1800 FREEDOM OF INFORMATION OFFICER o' s•d OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: October 18, 1999 Transmitted herewith is a copy of application No. 2265 for a Cesspool/ Septic Tank Construction Permit submitted by: Melanie Doroski for Melanie and Gerald Doroski 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 r,/{ DISAPPROVE Comments: Signat e IL) i4 4 io\ Dated ye ,r,,'"IIIA • /,''' OFFICE OF THE TOWN CLERK st'��` O�K TOWN OF SOUTHOLD est' v COG'_ Application No. ��' ELIZABETH A.NEVILLE,TOWN CLERK Construction P.O.BOX 1179 SOUTHOLD,NEW YORK 11971 G rn , Alteration Tele hone O,�' Qui' $10.00 - Residential p (516) 765-1801 =y�l ,•'� $25.00 -Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICAT ION for CONSTRUCTION or ALTERATION PERMIT OW- 1G9 SEPTIC TANK or CESSPOOL IOWA ClerK OUtf10itl Permit No. Fee $ DATE " 14//1 APPLICANT NAME: Melanie Doroski APPLICANT ADDRESS: 210 Broad Street, Greenport, NY 11944 SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION new single family dwelling LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: Gerald M. & Melanie Doroski OWNER MAILING ADDRESS: 210 Broad Street Greenport, NY 11944 OWNER PROPERTY ADDRESS: 65 August Lane Greenport, NY 11944 TELEPHONE NUMBER OF CONTACT PERSON: Gerald 381-9658 TAX MAP NO. : Section 53 Block 4 Lot 44.13 CROSS STREET: n/e corner of Kerwin Blvd & August Lane, Greenport BUILDING PERMIT NUMBER CROSS REFERENCE: r I' WW R. //(( Signa u eR��i pplicant RECEIVED BY: Town C erk's Office DATE: • 1 1, TE: `�-�,''c_�CE; SUFFOLK CO. HEALTH DEPT. APPROVAL 79 dp H. S. NO. ' 1.o7 Kid 5. SHOWN THUS: It REFER TO MAP cif. AL)CIA)ST AMES FILED INTHE 0AMENDEI7 MAP A PEC. VAN( EST' S.Es1s. St./0412C . l '5 OFFICE A5 MAP N0.9107 SuFt= OD• MAP NQ.. 1124 . In ( 2EsiveNCE) .r*. 0-0) __ _ . ', Ri VACANT' < STATEMENT Of . :-+.:t 1•I.79°54 COOO E. 131.Q2 - — IA4ENT THE DIOOSAL <1' ____ SYSTEMS FOR THIS RISIDENCE WILL O°' z ' 1 1I i w OP C'J A - Artg,� CONFORM TO THE STAND�tRDS OFA THE I SUFFOLK CO. DEPT. OF HEALTH SERVICES. 0 ' MAP OF PIZO P ERTY ' tSt `: APPLICANT ,� 2I L cis �J�.��Lt/EYEP PO1 SUFFOLK COUNTY DEPT.y OF HEALTH �' i ' _ r/' irk c ¢ +. [� 1 SERVICES — FOR APPROVAL FOR ' 1 : !G. %� �.-- -- _ N •� {C !D M.. TL. 0 � .1CONSTRUCTION ONLY a1D/ TE:' �`�i H. S. REF. NO.:Q / _ Air 1° OMAQU� APPROVED:- \ �� P� co._ / 'VACA�:� 1 a) �, rnwt� of S©���NO�O NY, 1 „ SUFFOLK CO. TAX MAP DESIGNATION: 1 o o - ijt' .. DIST. SECT. BLOCK PCL. �p 'Si', J \ q ;,,,--1,-;/ 1000 53 4 44. 13 \ '� OWNERS ADDRESS: / �'1 I �ci� OSS.\ �� PROp 210 620AD STf2EET t c /4‘'..1" O C? / -\'`� �� _ r, '° 3. lb I GREEN PO 2T, IJ.Y 1 t9 Z �t_ l - 6ry- - - - - __ N <' �� '_ OR on ' ��� l SCALE- 5011s I ��� 1835 t 'r. 1 j ` / AREA'49`6235.F DEED: L. N,/a, P. i1 ,p a=MONUMENT TEST HOLE STAMP : G .i , ' ` 1. = EXCAVATION INSPECTION AEQUii�EO , � o 30,� a 1,,5-syr.a a s violation of i `�L ts�, ,9 , 2 I ` FOR SANITARY SYSTEM R :nv haW Yn�. . 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