HomeMy WebLinkAboutFugosich, John •
OFFICE OF THE TOWN CLERKc3�FFU(/(t,
Town of Southold Olj
Judith T. Terry, Town Clerk .` t%
Town Hall, 53095 Main Road
P. O. Box 1179 cn
Southold, New York 11971 O - 4
Telephone - "OA J �
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 15 Residential X
Fee $ 10 . 00 Non-Residential
Septic Cesspool X
PERMIT ISSUED TO:
NAME: John Fugosich
ADDRESS: 160-28 24th Avenue
Whitestone , New York 11357
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New construction, single family dwelling
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: John Fugosich
OWNER MAILING ADDRESS: 160-28 24th Avenue
Whitestone, New York 11357
OWNER PROPERTY ADDRESS: Anchor Lane
Southold, New York
TAX MAP NO. : Section 79 Block 4 Lot 40
CROSS STREET: Cliffper Drive
BUILDING PERMIT NUMBER CROSS REFERENCE:
Ju idith.T. Terr
Southold Town Clerk
DATE: August 20, 1986
,. 1
(TOWN SEAL) '
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tri 0y fro, � Town Hall, 53095 Main Road
�', ill P.O.�t�\,_ Box 728
`�,'�j �����,��' Southold, New York 11971
JUDITH T.TERRY TELEPHONE
TOWN CLE Ri:
(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
August 20 , 1986
To: Victor Lessard, Southold Town Building Department
From: Judith T. Terry, Southold Town Clerk
Transmitted herewith is a copy of application No. 22 for a
CONSTRUCTION or ALTERATION Permit for a cesspool or septic system
submitted by John Fugosich
Please advise if the project has received Suffolk County Health
Department approval and if we may issue the permit .
Judith T. Terry
Southold Town Clerk
Attachments
OFFICE OF THE TOWN CLERK
Town of Southold
Judith. T. Terry, Town Clerk Application No.‘,7
Town Hall, 53095 Main Road Construction l�
P. O. Box 1179
Southold, New York 11971 Alteration
Telephone Residential t/
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
cs4--
��7
Fee $ /
DATE ()& a O ( CI 0f'‘
APPLICANT NAME: J c�lij /(J F 1 c S / /-f
APPLICANT ADDRESS: /6 O ~' 02 a /<24/45-
61A �Sr^v � � �• y //35-7
SEPTIC CESSPOOL /
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
ivraJ Co 475 d7,-( 0A)
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: J O h i) F- 1/ 60S / C--
OWNER MAILING ADDRESS: � - V�
h, Tom" S N- . f( 3 s 7
OWNER PROPERTY ADDRESS: fi N C-140 ,2 l /^I ry is
TELEPHONE NUMBER OF CONTACT PERSON: 7 /g 7 L
TAX MAP NO. : Section ' f Block 4 Lot lit 0
CROSS STREET: N' C-140 rt b I1 /t) F c a r PPER
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY{ ,4U.
Town erk's Of ice
DATE: azi 62.0 r (��
4 �
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OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk Application No.e
Town Hall, 53095 Main Road Construction
P. 0. Box 1179
Southold, New York 11971 Alteration
Telephone Residential t/ _
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Permit No.
cs4-
Fee $
DATE /q06. a o , r % t'
APPLICANT NAME: V O14 /() c L1 C2 S / e /�
APPLICANT ADDRESS: /649 — c2
tilA,%e-S 2- A) t/ GAS y f/37
SEPTIC CESSPOOL /
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
A/CLa C, Ns 7,€.v e?-f
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: j (d) N F- 1/ 60 S
OWNER MAILING ADDRESS: l 6 a 7 Kyr-
(A/At 7-e-
yr-
(A/At7-e- s7-0 �v�/ ,)_ (( ? S7
OWNER PROPERTY ADDRESS: /9 (' c-�(� ,� � j r.JE
TELEPHONE NUMBER OF CONTACT PERSON: - /c 7 4/4 ' 014,
TAX MAP NO. : Section ? I Block 14 Lot LLQ
CROSS STREET: re /-f9 F CI- I PPER 1 Vtr-
BUILDING PERMIT NUMBER CROSS REFERENCE:
jd,,,,A</ -*/,7(,747-
516'
Signature of Applicant
CEIVED BY{Yrc�,
Town erk's Of ice
DATE: 620r (y
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