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HomeMy WebLinkAboutSurozenski e" • JUDITH T.TERRY © Town Hall, 53095 Main Road •TOWN CLERK gg, P.O.Box 1179 • REGISTRAR OF VITAL STATISTICS •� O v 1� Southold,New York 11971 MARRIAGE OFFICER ��j '� Fax(516)765-1823 RECORDS MANAGEMENT OFFICER .q ED 'Vosiii Telephone(516)765-1800 FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1300 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : JOHN BERTANI BUILDER Address 1 : 1380 OAKWOOD DRIVE City St Zip SOUTHOLD NY 11971 Descripton of Proposed Construction or Alteration SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. SCHD REF. #R10-95-0015 Name Of Owner SUROZENSKI, JEROME & VIRGINIA Mailing Address 1 P. O. BOX 92 City St Zip CUTCHOGUE NY 11935 Property Address 1 CROWN LAND LANE City St Zip CUTCHOGUE NY 11935 Tax Map No. section 102.00 block 7 lot 3.000 Cross Street SPUR ROAD Building Permit Number Cross Reference: Issue Date: 3/23/95 Judith T. Terry Southold Town Clerk (TOWN SEAL) /c; e` JUDITH T. TERRY Town Hall, 53095 Main Road TOWN CLERKP.O. Box 1179 � Southold, New York 11971 REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823 MARRIAGE OFFICER ® ��® Telephone (516) 765-1801 RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER �� OFFICE OF THE TOWN CLERK 1 J J J J s TOWN OF SOUTHOLD MAR 1 6 1995 TO: Southold Town Building Department �C,L;.Ian��_PT.=� `' r g. FROM: Linda J. Cooper, Southold Town Clerk's Office TONOFSOUTI-101=P'=—'" DATED: March 16, 1995 Transmitted herewith is a copy of application No. 1347 for a Cesspool/ Septic Tank Construction Permit submitted by: John Bertani Builder for Jerome & Virginia Surozenski 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 �r DISAPPROVE Comments: mere c /l /(2—� e045— Signature / //c<5- Dated OFFICE OF THE TOWN CLERK ,,,,""" r Town of Southold ��•'�O��FfOL1(00- Application No. �� Judith T. Terry, Town Clerk �� [i Town Hall, 53095 Main Road Z .G . Construction P. 0. Box 1179 • r: v '-^ • Alteration • Southold, New York 11971 ‘ct� - �.• Telephone ;� y�Y �Q��•' $10.00 - Residential (516) 765-1801 -_ �l �, , $25.00 - Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ /C', tl� DATE -3/(5-/f5-- APPLICANT NAME: J664t, . e6e779‘A/ eve 24.967e_ APPLICANT ADDRESS: (3 (9.0, 0,44,0-6,9 >e/i. 3 v �1,,o-U) ( (97/ SEPTIC 'CESSPOOL ,I/• DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION -i:Po 27 c K trvon¢ w LOCATION MAP: . Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: Je,zoytE / j,0"4' --C70)20 OWNER MAILING ADDRESS: go , i c4 P� eiu1/-6 6'Oc 7(93/ /0 OWNER PROPERTY ADDRESS: 64553",4-/ /,6-a,(O TELEPHONE NUMBER OF CONTACT PERSON: ,pc,----/J— cz TAX MAP NO. : Section /0 Block 7 Lot CROSS STREET: SPc..Jf2_ R.-64-{) BUILDING PERMIT NUMBER CROSS REFERENCE: eYe-C4 1 4 Signature of Applicant RECEIVED BY: ALI / Town Crk's Office DATE: j/// ./2 • — SUFFOLK CO.HEALTH DEPT APPROVAL •� MAP OF P1?QPE1< 1 Y H S NO. • -- SU` ,VE`,IED- FOP_ MOLE FAMILY DIMELLPIi( ONL; ' jiEXPji:.:- r,, \A F vii-2(- 1 1\ { J IRES THREE YEARS FROM DATE OF APPROVAL r `� r".'Ir HOUSE) ' ;, �C)0 * N '1/ STATEMENT OF INTENT THE WATER SUPPLY AND SEWAGE DISPOSAL SO' ----ji / A7 SYSTEMS FOR THIS RESIDENCE WILL //‘' � CUTCE IOGUE CONFORM,.(fQS,TAHE i35T luf2�R�PS OF THE �� SUFFOLK(C -rlJaDwE F HEALTH SERVICES. { CO Tc\P/N QF OU t HQ ✓ f_•1:Y/ (S) �� U"a7F HE /'� • 1 APP ICANT i3 ----- lo��(r-u Rd• �T140v's a 1151 )L-1--133-1.- I SUFFOLK COUNTY EPT OF HEALTH SPU(t I�O�� r SERVICES - FOR APPROVAL OF \ //\ CONSTRUCTION ONLY '\ N.42 33 50�E. 179.1 1 - DATE: ( c�. ` H.S.REF NO.. C7 - l -D D A } O - ' / i-i V-1-5° T' ,/'/ AP' '.0,.. i Allir ' O .( i I 1 o // SUFFOLK CO TAX MAP DE'-GNATIO V o - U:- f) DIST. SECT BLOCK PCL / 9_ t' / (000 102 7 3 • / 1 (R in ' / OWNERS ADDRESS. 0 Pf2OP WELL ' 1 P O.>px 92 9. < (7.3CIALL- 30, I S Q o ro. 11o / A,` CA_I�1,7 �i`- i_ (734-(o71 I) �1� I I c ;_-;= MUNUMEF\;T DEED L. '4/A P S33( 3S Hi1d3N VA�f JK T.i 11 ----• --- AO '1,331 'a S I j , C' 12C F'l r'� TEST HOLE STAMP L LL P661 67. 330 S A,— P20P-SEPrtc' - 1= CESSPOOL ,- 0 507 EXP N ---ea 7-__ +r.,F S r to aaiii11331d oC,J 1\) .Lau,,... .c:.1 / I \ \ it '', • l3d _e c t-;uLytcr. L/ / \ t ,� AMENOFI2_DEC.,2).,_!.99_4 Y N I \ / (VACANT) _ SEAL / Ill /;';= NOTES; ,6 \ \ GUAILAtti t.✓ ;O PIG(Z"i H fyGf�tG bAf'JV. 1,1.01- NU,`--.. (QEF=_L-IU' MAP OF •...icv�/F\i LAN( LANE �'U T(Z_Cl5T_CO 9CC?MhIONWEALf_N [At�L TITLE I1:EJ ;a! 'rfs<:_Vt f: CC C.E ?_>r_S iFFtCI q'" MAP N:ie� 9c}. I� 14J5J(ZA1ti�EC�.-ST. l )*„ 2. :,.Ff CO TAY M,'. --:•A:'f:, 10'x0- 10-7-3 - \ RO_DERICK VAN TULP.C. /�r1 LICENSED LAND SURVEYORS i A - GREENPORT NEW YORK