HomeMy WebLinkAboutZloklikovits ,e1c31\gf afire'
" Town Hall, 53095 Main Road
$��' P.O. Box 1179
-‘-',17/
®o Southold, New York 11971
JUDITH T.TERRY - �� po� TELEPHONE
TOWN CLERK !!!�� (516) 765-1801
REGISTRAR Oh VITAL STATISTICS OFFICE OF THE TOWN CLERK
• TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No . 397 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : GERACI , KENNETH J .
Address 1 : DOGWOOD STREET
City St Zip SAG HARBOR NY 11963
Descripton of Proposed Construction or Alteration -
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY HEALTH
DEPARTMENT 7/18/88 .
Name Of Owner ZLOKLIKOVITS, JOHN
Mailing Address 1 RD 2 , 129Q BONNIE BRAE COURT
City St Zip GRANITE SPRINGS NY 10527
Property Address 1 NORTH SEA DRIVE
City St Zip SOUTHOLD NY 11971,
Tax Map No. section 54.00 block 5 lot 12 . 000
Cross Street KENNEYS ROAD
Building Permit Number Cross Reference:
Issue Date: 9/14/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
3
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Town Hall, 53095 Main Road
•, c,•- ., .: -' ,� P.O. Box 1 179
u 1� E.• Southold, New York 11971
JUDITH T.TERRY 'fl
��•- TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR Of VI I AL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: September 13, 1988
Transmitted herewith is a copy of application No. 403 for a Cesspool/
Septic Tank Construction Permit submitted by:
Kenneth J. Geraci for John Zloklikovits
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.
�/ltl'Lcc.�
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments: cam, tM r.L:e_c- .cc an olio 1.9-4- cir
\ %\11
c cam. Dam c�
Signature
Q1\ 13\A
Dated
osofui. •�
� ,..
A Town Hall, 53095 Main Road
13° P.O. Box 1179
�;' ,* Southold, New York 11971
JUDITH T.TERRY `'222zi27 TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR 01'VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
•
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: September 13, 1988
Transmitted herewith is a copy of application No. 403 for a Cesspool/
Septic Tank Construction Permit submitted by:
Kenneth J. Geraci for John Zloklikovits
•
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
DISAPPROVE
Comments:
•
•
•
Signature
Dated
OFFICE OF THE TOWN CLERK cj�VFULtr
Town of Southold
N.Y Application No. 3
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road (T-2 v,„;14 r5 Construction
P. O. Box 1179 ,yt
O,`�
. _ Alteration
Southold, New York 11971
Telephone 1*01 Ni\v, ' Residential c.--”"
(516) 765-1801 o
Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ /O / QQ
DATE ` ! ` U D
-�APPPPLICANT- NAME: N3--bl'," 7 Loki \ (o i 1-\--
APPLICANT
LICANT ADDRESS: ROA 2_ 1 -2-C7 9
-v-vIe s+pr�� s N /O27
SEPTIC CESSPOOL -X -
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Dt•ot.tit,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ' V��` C1e4r1
OWNER MAILING ADDRESS: b c
U0®
OWNER PROPERTY ADDRESS: f Vo 4-l\ Se ,tri, cO0 -Ind\(%t
TELEPHONE NUMBER OF CONTACT PERSON: (5/6) '725 - (3J 3
TAX MAP NO. : Section 05-4/ Block Lot / 2-
CROSS
CROSS STREET: N6-('-t-k 9e.
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signatur f App scant
RECEIVED BY: 4s(zek,
Town C rk's Off e
DATE: RECEIVED
sE.P 1 3 1988 -
Tnn CM Witt
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SUFF.CO. HEALTH DEPT.APPROVAL I H.S. NO.
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SUFF. CO. DEPT.OF HEALTH SERVICES STATEMENT OF INTENT
TEST HOLE
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FOR APPROVAL OF CONSTRUCTION ONLY
GI Y
c..-,•tlJ THE WATER SUPPLY AND SEWAGE i
__-____._ _y__. J' 7r/it DISPOSAL SYSTEMS FOR THIS RESI-
Virscrif 1 DATE:
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_ DENCE WCONFORM TO THE
<5 STANDARDS OFILL SUFFOLK CO. DEPT.
H.S. REF. NO : I
��/Kc..::;;V - OF HEALTH. SERVICES. i
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APPROVED: {
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