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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK : ® • P.O. Box 1179
th Southold, New York 11971
REGISTRAR OF VITAL STATISTICS V® �,' Fax (516) 765-1823
MARRIAGE OFFICER ej' ®I�� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER = ��
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. 1227 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 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 TASKER, ARTHUR
Mailing Address 1 5 DARTMOUTH STREET
City St Zip FOREST HILLS NY 11375
Property Address 1 17 BEACH STREET
City St Zip GREENPORT NY 11944
Tax Map No. section 3.00 block 3 lot 11 .000
Cross Street BAY AVENUE
Building Permit Number Cross Reference:
Issue Date: 10/17/94 Judith T. Terry
Southold Town Clerk
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(TOWN SEAL)
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® -; ' P.O. Box 1179
,.,, ' Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
® �o% Fax (516) 765-1823
MARRIAGE OFFICER oj' ��� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER -_ ®� i�.
FREEDOM OF INFORMATION OFFICER �"._,,,,,,.i qTrffin'"75-
9Y
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD OCT 1 4 1994 I'' )
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TO: Southold Town Building Department k BLDG ILFP=
TOWN Or SOt,1Tr r
FROM: Linda Cooper, Southold Town Clerk's Office HOLD
DATED: October 14, 1994
Transmitted herewith is a copy of application No. A1277 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Stanley Skrezec for Arthur Tasker ,
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.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE - '4::------
COMMENTS:
::--' 'COMMENTS: Maintain required setbacks from adjacent wells, buildings,
property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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Signature
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Date
OFFICE 6F THE TOWN CLERK ,,,'"""'
Town of Southold ,''� ��FF���j�+.
Judith T. Terry, Town Clerk ,i/ crGt Applicatior5'✓No./�77
Town Hall, 53095 Main Road Construction
P. O. Box 1179 Alteration !� L
Southold, New York 11971 ‘ 01 rn /
Telephone ui;,tk ® i $10.00 - Residential C�
(516) 765-1801 -.1 'P
,, ' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
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Permit No.
Fee $
DATE OCA- l 3/ (9 9{
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APPLICANT NAME: S(cn -z�G
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APPLICANT ADDRESS: S O- GLL< yPcM.0 L,q-ivcc
6-(46-6120/Vi7 it/t
SEPTIC CESSPOOL X
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION it\M
+D CAN-0. C �s10-0c, 57
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: /-c-t L u2 TA
OWNER MAILING ADDRESS: S'
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OWNER PROPERTY ADDRESS: \ 1 gYACIk 1141 -- .4C-SAWIDIta364-C14--"
G1 0-kiT, A v b". Vi `141
TELEPHONE NUMBER OF CONTACT PERSON: I-47 / - 10 2-2°
TAX MAP NO. : Section 3 Block 3 Lot /(
CROSS STREET: Q4 V l�1�k:affil
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature Applicant
RECEIVED BY:
Town Ierk's Office
DATE:
P
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