HomeMy WebLinkAboutWruck, Frank Jr �'c FFOL
ELIZABETH A.NEVILLE ).�0 Gym Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
N Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER Z �' Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER of �0�(1 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER %- 49l a
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1959 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JERRY CICCIARI
Address 1 : 120 HAYRICK LANE
City St Zip COMMACK NY 11725
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 #R10-98-0152
Name Of Owner WRUCK, FRANK W. JR.
Mailing Address 1 3583 TONOPAH STREET
City St Zip SEAFORD NY 11783
Property Address 1 MOUNT BEULAH LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 51 .00 block 3 lot 2.008
Cross Street SOUNDVIEW
Building Permit Number Cross Reference:
Issue Date: 11/02/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE �' � yam►
TOWN CLERK o < P.O. Box 1179
•REGISTRAR OF VITAL STATISTICS • Southo : 1
MARRIAGE OFFICER , 0*. t Telephone (516 ' .'Li::'
RECORDS MANAGEMENT OFFICER SIJ a 11
FREEDOM OF INFORMATION OFFICER %- ell jig ' ..i�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 21 , 1998
Transmitted herewith is a copy of application No. 2035 for a Cesspool/
Septic Tank Construction Permit submitted by:
Jerry Cicciari for Frank W. Wruck Jr.
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:
gnatu
1o/ Ijci 9
Dated
, . .
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OFFICE OF THE TOWN CLERK , c0,Ffilx`,D
Town of SouTown Clerk �, ''' . ~ y Application No.Z035
Judith T. Terry,
Town Hall, 53095 Main Road FA , 1 Construction X
P. O. Box 1179 Y
Southold, New York 11971 0�, Alteration
•
Telephone Olt sO ` Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ I9
DATE i0 [2--ilib
APPLICANT NAME: \/ CA,(Li?/1i,i ' i jAv ( 1 A •a-L1t/
APPLICANT ADDRESS: (k) HjPi 1WE t 4--11-'111-64401 ( 014
SEPTIC / CESSPOOL (ejt.etne..pi,clig_31c)
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
A OlUE ' h d�11 L .- �'.dN�S �
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: rtAioK ,, WAoorI 072,
OWNER MAILING ADDRESS: .1S&? —rDNofAH o
Arapdog . 11-7273- 300
OWNER PROPERTY ADDRESS: %40J',
TELEPHONE NUMBER OF CONTACT PERSON: "i 1 1+ -O/40
TAX MAP NO. : Section 5 j Block 3 Lot 2 ,,
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CROSS STREET: COJ J pytIL] U600 6
BUILDING PERMIT NUMBER CROSS REFERENCE:_.
Sign.ture of Applicant
RECEIVED BY: o2 0
Tow Clerk's Offi e
DATE: 7O/0/ � �
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