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JUDITH T.TERRY ` `, • Town Hall, 53095 Main Road
TOWN CLERK - ,"' ' 4 P.O.Box 1179
REGISTRAR OF VITAL STATISTICS O +,� Southold,New York 11971
MARRIAGE OFFICER �� V I� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER : 04 V„ITelephone(516)765-1800
FREEDOM OF INFORMATION OFFICER 0,°1°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1354 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : STANELY F. SKREZEC
Address 1 : 50 GULL POND LANE
City St Zip GREENPORT NY 11944
Descripton of Proposed Construction or Alteration
ADDITION OF A CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner SPERLING, MRS. NANTHAN I EL
Mailing Address 1 503 MAIN STREET
City St Zip GREENPORT NY 11944
Property Address 1 1115 MAIN STREET
City St Zip GREENPORT NY 11944
• Tax Map No. section 34.00 block 1 lot 13.000
Cross Street KNAPP PLACE
Building Permit Number Cross Reference:
Issue Date: 7/12/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/ 3 CV
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® ' ale P.O. Box 1179
cr .W ,� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
0I Fax (516) 765-1823
MARRIAGE OFFICER =__ 4' ® �� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER i * �
��/ 0
FREEDOM OF INFORMATION OFFICER „ iii
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OFFICE OF THE TOWN CLERK I F H R a r 1 II -------n] i
TOWN OF SOUTHOLD i J FIC , i 1
I.r'_„_� JUL ;
i
TO: Southold Town Building Department if d U 1995 {
FROM: Linda Cooper, Southold Town Clerk's Office t ELI,'; -L-7,-;77----------i'
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10, 19951C-41-1a/:/- ,
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DATED: July
Transmitted herewith is a copy of application No. A1406 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Stanley F. Skrezec for Mrs. Nathaniel Sperling .
Please review the application and. location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
4I-'74-a--4-1
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - K.-
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
IZE 4/, , sk i,,,,,
Signat }e P
JUL 1 2 1995 // —
Town Clerk Soutfiitd Date
OFFI-O -.OF THE TOWN CLERK ,,,'""""•-.
4 ' Town of Southold .0" �FfgUr
Judith T. Terry, Town Clerk ,,'��� ��l/� Application No. yG
Town Hall, 53095 Main Road Z Construction
P. 0. Box 1179 --------
Southold,
Southold, New York 11971 - . tt3 �",' Alteration
Telephone
...,----
‘04.,� 0���'� $10.00 - Residential
(516) 765-1801 _ of ���'e
$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 '1( (cts'
APPLICANT NAME: 51F Ni.F7 F' Skas c
APPLICANT ADDRESS: TO G►uL.L Po-Nib Alb—
GAGar i A)(1.!y k ilk(
SEPTIC CESSPOOL t
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION Al* /
eigigra- TV sA47-01-7
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LOCATION MAP: Must be attached hereto before permit may be issued.-
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: S ' 4Ath(L ST-6R-1.;'1411,
OWNER MAILING ADDRESS: �0iti1,I%;N' V.
OWNER PROPERTY ADDRESS: II ( 5- Akiftiriai ST,
(19 te V
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section Block / Lot Y3
CROSS STREET: ,N i-'P ?t-401--L6—
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Sig Iture o A If. a-nt
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RECEIVED BY: W . J
,9 Town clerk's Office
DATE: �J // 6 f
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