HomeMy WebLinkAboutKrupski, Raymond '���iii ••
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OFFO(,�
ELIZABETH A.NEVILLE y0 0l/y� Town Hall, 53095 Main Road
TOWN CLERK c < P.O. Box 1179
N 2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � $ Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER N.,4% �0-I1 Telephone (516) 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. 2020 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : RAYMOND & CELELIA KRUPSKI
Address 1 : 940 TUCKERS LANE
City St Zip SOUTHOLD NY 11971
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 #R10-99-0009
Name Of Owner KRUPSKI, RAYMOND & CECELIA
Mailing Address 1 PO BOX 1772
City St Zip SOUTHOLD NY 11971
Property Address 1 13780 SOUNDVIEW AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 54.00 block 3 lot 4.000
Cross Street HORTON'S LANE
Building Permit Number Cross Reference:
Issue Date: 3/02/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
„, ,,,R) 0)- 6
ELIZABETH A.NEVILLE Town Hall, 53095 Main Road
TOWN CLERK 1 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS N Southold, New York 11971
MARRIAGE OFFICER
�a Fax (516) 765-1823
zy4 a%\-• Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
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: March 1 , 1999
Transmitted herewith is a copy of application No. 2100 for a Cesspool/
Septic Tank Construction Permit submitted by:
Raymond and Cecelia Krupski
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
DISAPPROVE
Comments:
7)Si nature
Dated
,
OFFICE OF THE TOWN CLERK ,'''4\O1Z
TOWN OF SOUTHOLD 'O �l CgG 0 Application No.&1O0
ELIZABETH A.NEVILLE,TOWN CLERK /41 t/
P.O.BOX 1179 : /aZ:• Construction
SOUTHOLD,NEW YORK 11971 . .....p ; Alteration
y�i�� ire' $10.00 - Residential /0
Telephone
(516) 765-1801 = atmir��'' �
� $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ /0,6o //
DATE 34 //9 9Y
APPLICANT NAME: ,4yA dA/6 'ib CEC!'Gr',4 ',f' f,Ose,'
APPLICANT ADDRESS: 9 '° TCf Gtr ,P `r /4W 40 BOX /7 7 2
S6 Le 7-4 O GO A6S41 yd A 1177/
SEPTIC ' CESSPOOL ‘"---
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
(IGS 4/J7 ,2,4e-7 Q W6 P4-44/L , 0 L✓/' LG;N" 6 4/i 77* r9'74-ci/eda
O 4 *-ari %%O , . 6-6,es
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 4Y/ZJQK4. ,-/y6 cF«'y,47,4 /c',EGt/,1k(
OWNER MAILING ADDRESS: /06. do x /77a
fel u 77-4 o L d, N6'41 yd iQ, //97 /
OWNER PROPERTY ADDRESS: /3 78-0 5'44'✓bdr" ter/ /a r/.c,Vc`i
Sae.,-74,c t ) 'VC A/ V& // -7/
TELEPHONE NUMBER OF CONTACT PERSON: (5(6) - 76 S 5-6/e
TAX MAP NO. : Section 0544 00 Block O3,o o Lot DO y, O o
CROSS STREET: I/C,e7o /v, s 4AAc6:
BUILDING PERMIT NUMBER CROSS REFERENCE:
4 „_
Signature of Applicant
RECEIVED BY : AL/ AZIL-I .LQ__
Town Clerk's Office
DATE: - ////7e
Vizi,'
DATE.JAN 21 199 x .Noll 10 ,9q,-000
APPROVED �
�
FOR MAX,i ,10.M Or^^ , Et,D:OOHS
* E:-CIYIRES Timm YEARS FR,0M DATE OF APPROVAL
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CESSPOOL
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CESSPOOL 494-7-.-9)
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