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JUDITH T. TERRY : 1 Town Hall, 53095 Main Road
TOWN CLERK v rZ P.O. Box 1179
tla Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ; %V' Fax (516) 765-1823
MARRIAGE OFFICER .j' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER '— 7® 4 r•
FREEDOM OF INFORMATION OFFICER
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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. 1134 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
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
ADD CESSPOOL TO AN EXISTING SYSTEM. FILL IN PREVIOUS BRICK CESSPOOL.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner MARTIN, VIRGINIA
Mailing Address 1 SONNER, DORIS
400 BAY ROAD
City St Zip GREENPORT NY 11944
Property Address 1 400 BAY ROAD
City St Zip GREENPORT NY 11944
Tax Map No. section 43.00 block 5 lot 8.000
Cross Street GULL POND LANE
Building Permit Number Cross Reference:
Issue Date: 5124/94 Judith T. Terry
Southold Town Clerk
(TOWN SAL
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JUDITH T. TERRY : _ , t Town Hall, 53095 Main Road
TOWN CLERK ® ', P.O. Box 1179
t Southold, New York 11971
REGISTRAR OF VITAL STATISTICS oY t!' Fax (516) 765-1823
MARRIAGE OFFICER _ej� I.' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER 1 °fir—' _
FREEDOM OF INFORMATION OFFICER =�...r,rovr ���!
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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TO: Southold Town Building Department ; �1AY,, /i:a
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FROM: Linda J. Cooper, Southold Town Clerk's Office f _,/ ,
DATED: May 16, 1994 L Tope®F.®-PT ,_...
- S®OTHOLD
Transmitted herewith is a copy of application No. A1173 for a Cesspool/
Septic Tank Construction Permit submitted by:
Stanley F. Skrezec a/c Doris Sonner & Virginia Martin •
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 recommmmendations:
APPROVE � VO?'
DISAPPROVE - ' uiID
Comments: `7, / ' f�e ���
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Signatur
Dated ..
OFFICE OF THE TOWN CLERK ,,'",,,,
Town of Southold
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Town Clerk �'. �� �Ol/ Application No.4 r i'
Judith T. Terry, � �, . y'
Town Hall, 53095 Main Road „''
Construction
P. O. Box 1179 o ` • ,T, �
Southold, New York 11971 ••• cr1 �, Alteration
Telephone ""Aro $10.00 - Residential I
(516) 765-1801 = 1
' $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 Mau 1 (p 15ct
APPLI CANT NAME: Cza-Y+A)153 y /--, �; �
APPLICANT ADDRESS: l est,,6 (�✓d-w�T—
G--eI e a-ii `�v �1 S L j y
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION A-bp C
C� -- `eee l S/U ve G - ' ii \ • Ia*. L Q P L.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: -)”IS So N n/e r-
OWNER MAILING ADDRESS: Li ®0 RAY P-0 Pt-z)
,2&-Z'po-rig- ) A' f Y 11 Li Li
OWNER PROPERTY ADDRESS: S � � �
TELEPHONE NUMBER OF CONTACT PERSON: Li') -7 _- / 8 -
TAX MAP NO. : Section `-I 3 Block _5 Lot U
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Sign ture of A plicant
RECEIVED BY:,, /
To fn Clerk's Office RECEIVED
DATE: �//6 9
AY 1 6 1994
Southold Town Clerk
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