HomeMy WebLinkAboutNorth Fork Housing Alliance 0 �V/. G�
JUDITH T. TERRY z Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
y Fax (516) 765-1823
MARRIAGE OFFICER ® ®� v
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_et �1D �� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 964 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : BENNETT ORLOWSKI
Address 1 : P. O. BOX 297
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES.
Name Of Owner NORTH FORK HOUSING ALLIANCE
Mailing Address 1
City St Zip GREENPORT NY 11944
Property Address 1 WALNUT AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 142.00 block 1 lot 12.000
Cross Street FACTORY AVENUE
Building Permit Number Cross Reference:
Issue Date: 3/03/93 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY 11.o. .G Town Hall, 53095 Main Road
TOWN CLERK z ® T P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS , I .tri . Southold, New York 11971
�� Fax (516) 765-1823
MARRIAGE OFFICER / i ® ®�' •
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OFFICE OF THE TOWN CLERK ,�
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TOWN OF SOUTHOLD ; l�•
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TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town- Clerk's Office
DATED: February 26, 1993
Transmitted herewith is a copy of application No. 991 for a Cesspool/
Septic Tank Construction Permit submitted by:
Bennett Orlowski for North Fork Housing Alliance _
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.
1E2'`-14_a cel .
Linda J. Cooper •
* * * * * * * • * * * * *
I have reviewed the application and location map of the project cited above -
and make the following recommendations:
APPROVE ,' \
DISAPPROVE
Comments: � P`
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Signature
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Dated
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OFFICE OF THE TOWN CLERK • c.Vrl"G(,{-v
Town of Southold
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Judith T. Terry, Town Clerk r. -
r-" ', ✓� Application No. 9
,
Town Hall, 53095 Main Road o r�: �' L--
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Town
O. Box 1179 �' ••1;` � , ;' n Construction c/
Southold, New York 11971 p:, -''' =%'"' Alteration
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Telephone 1 x •t Residential
(516) 765-1301 �,�
Non-Residential
• TOWN OF SOUTHOLD
.
SOUTHOLD WASTEWATER -DISPOSAL DISTRICT -
— APPLICATION
• for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Permit No.
Fee $
•
DATE
APPLICANT NAME:
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APPLICANT ADDRESS: QA(L vZ •
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SEPTIC__CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION /,4c s
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: ' -
OWNER OF PROPERTY:
• OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: 0 Qom,
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TELEPHONE NUMBER OF CONTACT PERSON:
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TAX MAP NO. : Section /y Block
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• CROSS STREET: =- __.;t p.:""— _
BUILDING PERMIT NUMBER CROSS REFERENCE:..
1,
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Signa re of Applicant
RECEIVED BY: v"
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/ Towi I=rk's Office
DATE: " `i•`- i
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,e (DWELLINI
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WELL &
CESSPOOL
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The locations of wells and cesspools shown hereon era 'r: •• r.:'i (IS
AREA = 5,959aa.ft observations and or from data obtained from others. r-...) `-'
The water supply and sewage disposal
Prepared in accordance with the minimum systems for this residence will conform '
standards for title surveys as established to the standards of The Suffolk County
by the LJ.A.L.S. and approved and adopted Department of Health Services.
for such use by The New York Stale Land
Title Association. '
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CERTIFICATION ADDED. °6%74/92
88 - 144