HomeMy WebLinkAboutPekunka (2) / 01 o ®���FUllr`e -
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JUDITH T. TERRY : , �_ Town Hall, 53095 Main Road
TOWN CLERK ® rP.O. Box 1179
to •) Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �. ,, Fax (516) 765-1823
MARRIAGE OFFICER 'e 0 0.3' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER _ 1 0.
FREEDOM OF INFORMATION OFFICER ''„•,,,i...°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1133 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
ADDITION OF CESSPOOL(S) TO DRAINAGE SYSTEM (CONSISTS OF GREASE TRAP)
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, WATER BODIES, AND 2' ABOVE GROUND WATER.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner PEKUNKA, MITCHELL
Mailing Address 1 475 PIPES NECK ROAD
City St Zip GREENPORT NY 11944
Property Address 1 475 PIPES NECK ROAD
City St Zip GREENPORT NY 11944
Tax Map No. section 53.00 block 1 lot 6.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 5/24/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL-1
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JUDITH T. TERRY Z-64:'—. _ Town Hall, 53095 Main Road
TOWN CLERK t ® i' P.O. Box 1179
to Southold, New York 11971
--REGISTRAR OF VITAL STATISTICS = V® .,,` Fax (516) 765-1823
MARRIAGE OFFICER _ s,' �1� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER =4&., .4;.:r
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FREEDOM OF INFORMATION OFFICER ''''''.,...,,,,011
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OFFICE OF THE TOWN CLERK R
TOWN OF SOUTHOLD i I t [5 0 _ '
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TO: Southold Town Building Department 7 '9�� '
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FROM: Linda J. Cooper, Southold Town Clerk's Office rowl4LDG.DEPT__-
DATED: May 16, 1994 OF-4X/7-HOLD y;
Transmitted herewith is a copy of application No. A1172 for a Cesspool/
Septic Tank Construction Permit submitted by:
- - Stanley F. Skrezec a/c Mitchell Pekunka .
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 recommenda 'ons:
APPROVE O'CAVATION INSPECT{ON
DISAPPROVE RE tdUORED
Comments: ji.di'aem / , . ,c J 0. f. _,tea ,�+, /
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'AIII-; , _age. '
Signature '
Dated
OFFICE OF THE TOWN CLERK ,,,'",,," ,�
Town of Southold ,,.04 cgfMiro'' Application No f r9
Judith T. Terry, Town Clerk �� y
Town Hall, 53095 Main Road Z !< ; Construction
P. 0. Box 1179
Southold, New York 11971 , -��cc13 T,� Alteration
V
Telephone _ �, 0 � _ $10..00_ - Residential
(516) 765-1801 - 1. 41- $' $25.00 Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
Jt '
for' ; .}
CONSTRUCTION7or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE rimy / 6/ 7 r v
APPLICANT NAME:
APPLICANT ADDRESS: 'O (v ti C. piv-1>
6_0....6-15710-p...7--- i � i e yk1iSEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION t . '
-VcoLf77 k 1 �
S %/Il 2ft"e5-4 —"
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: �� '�J- LS`L� 1 k1s+r,/YC,-
OWNER MAILING ADDRESS: P, Pe
(9�--O007 I' a Ti e ci q
OWNER PROPERTY ADDRESS: S,e')vtec
TELEPHONE NUMBER OF CONTACT PERSON: t--t ") -- ! 8 T"1_
TAX MAP NO. : Section �3 Block 1 Lot
CROSS STREET: v±2 2
BUILDING PERMIT NUMBER CROSS REFERENCE:
Sig ature of 'pplic= t
•
RECEIVED BY: C`y � RECEIVED
Town erk's 0 fice
DATE: \_//6/97 MAY 16 1994
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Southold Town Clerk
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