HomeMy WebLinkAboutGlowacki, Clarence JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK t T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS irk Southold, New York 11971
MARRIAGE OFFICER yQ O�' �t, Fax (516) 765-1823
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(516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 958 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : P. O. BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITON OF CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. HOLD 12'0" SEPARATION AND CALL FOR EXCAVATION
INSPECTION.
Name Of Owner GLOWACKI, CLARENCE
Mailing Address 1 R.R. 1, BOX 48 MARLENE LANE
City St Zip MATTITUCK NY 11952
Property Address 1 2020 MARLENE LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 144.00 block 2 lot 31 .000
Cross Street PECONIC BAY BOULEVARD
Building Permit Number Cross Reference:
Issue Date: 2/05/93 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK : 0 T .,. _g,p. Bbx 1179
REGISTRAR OF VITAL STATISTICS IP �` Southold, New, York 11971
MA IAGE OFFICER
Fax (516) 765-1823
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/ OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: February 2, 1993
Transmitted herewith is a copy of application No. A985 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Clarence Glowacki
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 - X
DISAPPROVE -
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40`11 . Date
OFFICE OF THE TOWN CLERK ,,,'",,,"""''-
Town of Southold ;'� ,ci\VOLKQ'� = Application No. 7,7c5.--/Judith T. Terry, Town Clerk $���% Gy
Town Hall, 53095 Main Road !< ; Construction
P. O. Box 1179 : v rsn ; Alteration
Southold, New York 11971 .tf'i /
Telephone ;`'O,A. ���i/ $10.00 - Residential
(516) 765-18014( 1
�' $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE a2 /7
APPLICANT NAME: 17"--71( lfd-�> 0(
APPLICANT ADDRESS: 972
2.
7714
SEPTIC CESSPOOL
DESCRIPTIQN OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto,I4efore permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALT " ? N.,
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OWNER OF PROPERTY:
OWNER MAILING ADDRESS: 44,?
OWNER PROPERTY ADDRESS: t,2_ C) MAS �t-�-
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section / 4y Block Z Lot ,j/
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
40-1-Zif
Signature of Applica
RECEIVED BY: (A1/4)44-
own
Clerk's Office
DATE: ��
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