HomeMy WebLinkAboutOlinkiewicz ' r
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Town Hall, 53095 Main Road
, ��$ P.O. Box 1179
=r�® IP" Southold, New York 11971
JUDITH T.TERRY '= „ � FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 503 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : OLINKIEWICZ, JOHN P.
Address 1 : P. O. BOX 942
City St Zip SHELTER ISLAND NY 11964
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 5/1/89.
Name Of Owner OLIKIEWICZ, JOHN P.
Mailing Address 1 P. O. BOX 942
City St Zip SHELTER ISLAND NY 11964
Property Address 1 BROWN STREET
City St Zip GREENPORT NY 11944
Tax Map No. section 48.00 block 3 lot 25.001
Cross Street NINTH STREET
Building Permit Number Cross Reference:
Issue Date: 6/06/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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I JUN m 11989 W-7-eiit*,4_!-A
it-I _ i� ,i %`� „,..1,4_,„,,fv`„ `� � ' Town Hall, 53095
a+ ..r � �� �o �. Main Road
br N OF OUTH `�y\` q I C” ��� P.O. Box 1179
F�� �. �r _ � �®I►+ Southold, New York 11971
E`r
JUDITH T.TERRY y ��"c/i///°� TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: June 1, 1989
Transmitted herewith is a copy of application No. 515 for a Cesspool/
Septic Tank Construction Permit submitted by:
John P. Olinkiewicz - - - •
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 IX
DISAPPROVE
•
Comments: cam, L Lth. & Ire ar. XCitles
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Dated
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OFFICE OF THE TOWN CLERK c31FIlL'(e0 _
Judith
TT.own TerryouTownn Clerk < ' .thold ' �-
�_ . Application No.
Town Hall, 53095 Main Road c r x' Construction
P. O. Box 1179 d.
� � Alteration
Southold, New York 11971 ,,1%;44t •
Telephone • �1 f Residential
(516) 765-1801 "' Non-Residential
TOWN OF SOUTHOLD
A
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.�
Fee $ , 0-0
DATEV.,1L. SS. , d9g9
APPLICANT NAME: O N� ?- Di_lt\O-YUCV-tiCe
APPLICANT ADDRESS: 0 lov °Wit-
tscrraDe tug 11804
SEPTIC CESSPOOL 3
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION C,4vtMucr- SurE )t( CE
w/o A c tic- it l S Pocr t, S K S'p . Go N s t 5i1 afcr (kms enctiohr Coi 60 Gam)/
lo- 3 LEricrlpocLs
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: S N vl
OWNER MAILING ADDRESS: S 1vbt;
OWNER PROPERTY ADDRESS: BEbw J ST-
(y' REJ J Porz7'
TELEPHONE NUMBER OF CONTACT PERSON: S-% qci bN(ILJ
TAX MAP NO. : Section U Block 5 Lot 2 C11
CROSS STREET: NIMS lA
BUILDING PERMIT NUMBER CROSS REFERENCE:
y?vv,
0 9i;V
Signature of App is nt
RECEIVED BY :
RECMY :
F , _ awn Clerk's Office
DATE: JUN 01 1969
Ton ad 4211..
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' FOR APPROVAL OF CONSTRUCT!
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SUFFOLK CO. HEALTH DEPT. APPROVAL ts.`
41H. S. NO.
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:c )i'—, /"� { f,' i i r 'f ;" ' + STATEMENT OF INTENT
L,_ bP I, J(.. -. F" , ,,�,f —� # - THE WATER SUPPLYAND SEWAGE DISPOSAL
SYSTEMS FOR THIS RESIDENCE WILL
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CONFORM TO THE STANDARDS OF THE
% � ,yam } _ I i �' SUF(OL kO. DEPT. O • LTH SERVICES.
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A.-1... SUFFOLK COUNTY DEPT. OF ,EALTH
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H. S. REF NO.:
SERVICES APPROVED
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SUFFOLK CO. TAX MAP DESIGNATION:
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OWNERS ADDRESS:
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LOAMY, v�l.d true copy.
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COARSE SAND ''441
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GLIA.ft k1 "F y 'IQ
TITLE lC_ _05.4.,As.1N5UrektgcE WATER.IN
CO,c:r' TO r OiJ t i.l L"s SA`u t l� '. EtAJ,l6_` COARSE!SAND "..k? v `.? \ ,
3 p-6 �t�r\iEYff.ii JUN E :'.2.,I a �•_�(�.,•^�. �.��
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RODERICK VAN TUYL, P.C. i;{ {ta• ci'-�;,•• ,1 r- !
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LICENSED LAND SURVEYORS 1541
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GREENPORT NEW YORK
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