HomeMy WebLinkAboutRose JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® .' P.O. Box 1179
U' Southold, New York 11971
REGISTRAR OF VITAL STATISTICS V® �. lie (516) 765-1823
MARRIAGE OFFICER /,�® ie' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER _ 1 it
FREEDOM OF INFORMATION OFFICER �:� lr �,I
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1123 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : STANLEY F. SKREZEC
Address 1 : 50 GULL POND LANE
City St Zip GREENPORT NY 11944
Descripton of Proposed Construction or Alteration
INSTALL 6' OF DRAINAGE RINGS FOR CESSPOOL. DISCONNECT FROM NEIGHBOR'S
APPROVED AS SUBMITTED. MAINTAIN REQURIED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner ROSE, ALFRED
Mailing Address 1 MAIN ROAD
City St Zip ORIENT NY 11957
Property Address 1 MAIN ROAD
City St Zip ORIENT NY 11957
Tax Map No. section 17.00 block 6 lot 9.002
Cross Street OSPREY ROAD
Building Permit Number Cross Reference:
Issue Date: 5/11/94 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY! - Town Hall, 53095 Main Road
TOWN CLERK y P.O. Box 1179
td'e �� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
‘4.49. �� Fax (516) 765-1823
MARRIAGE OFFICER ;#4 to a�®I��� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ®,l 1�
FREEDOM OF INFORMATION OFFICER "'�,��.,hili°°',I
_ P
OFFICE OF THE TOWN CLERK r.
TOWN OF SOUTHOLD (O pi
: /fig1�;
TO: Southold Town Building Department e� 4 iiv,�'
FROM: Linda J. Cooper, Southold Town Clerk's Office 'o' s®Fpr ./.
DATED: April 28, 19921 O
Transmitted herewith is a copy of application No. 1162 for a Cesspool/
Septic Tank Construction Permit submitted by:
Stanley F. Skrezec For Alfred Rose •
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.
6
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE �� EXCA - ,--.-r i ION
DISAPPROVE a;,_ L --)
Comments: ,- -,42,--/ • - ' '/ I`� /
MOVED
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MAY 1 $ 1994 s"i f lz/€49 .,t '-�-g
_ ion Clerk DOA
CAVK"u" TED Signature
C4—A- 424
Dated
OFFICE OF THE TOWN CLERK ,,,'",,,,""'--
Town of Southold •'�•��j�FF��K�'® = Application No. //6Judith T. Terry, Town Clerk ,' Gy
Town Hall, 53095 Main Road ;$ Construction
P. O. Box 1179 ; c ,_
Southold, New York 11971 fpAlteration
Telephone vie
4 ° ..��� � , $10.00 - Residential
(516) 765-1801 '.Ol l ,, ' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. /1 `�-
Fee $ j 0 .0o
DATE PrFI..I.L_ , qq
APPLICANT NAME: Snarr4LiSCV V, S, 716'4,,,.
f
APPLICANT ADDRESS: pewt 44
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SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
ti‘4 C r -' @.�'T' A at.0-6.11:7- ii r
14 •�, wonw enc, AttiA:. S
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Li1t ). 49r, am'
OWNER MAILING ADDRESS: ill, 411,, 9 ,Trveril
F r «
OWNER PROPERTY ADDRESS: S ,c'_c
TELEPHONE NUMBER OF CONTACT PERSON: th--)-154y
TAX MAP NO. : Section / 7 Block 6 Lot 9',
CROSS STREET: Q5P2,I57 (Lv,
BUILDING PERMIT NUMBER CROSS REFERENCE:
SYgnature of Applicant
RECEIVED BY: AL>/(ZA-6---z--c.Q
,'// Town Clerk's Office
DATE: 4 // x7577
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