HomeMy WebLinkAboutGrabaski, Agnes 00 OF°
Town Hall, 53095 Main Road
‘104„. '�� .O. Box 1179
=I 01 �.00.� Southold, New York 11971
JUDITH T.TERRYFAX(516)765-1823
•� TELEPHONE(516)765-1801
TOWN CLERK
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 540 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECON I C CESSPOOL
Address 1 : P. O. BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF ONE OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. NOTE: EXCAVATION INSPECTION REQUIRED.
Name Of Owner GRABASKI, AGNES
Mailing Address 1 MAIN ROAD
City St Zip MATTITUCK NY 11952
Property Address 1 MAIN ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 108.00 block 4 lot 1 .000
Cross Street EASTWARD COURT
Building Permit Number Cross Reference:
Issue Date: 8/29/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
.•up Fe ,,•��'C.��1 Fo ••_
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AUG 25 1989 a ..
' rF/ ; .� '�� Town Hall, 53095 Main Road
BLDG DEFT. .444:.'
_f'111 �.a� •• P.O. Box 1 179
TOWN •F SOUTHOLD Southold, New York 11971
JUDITH T. TERRY "'/ "I� TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
August 25, 1989
To: Victor Lessard, Southold Town Building Department
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A554 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Agnew Grabaski
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 - DC,
DISAPPROVE -
COMMENTS: a , � � u.s.N nq
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4,
40
Signature
t.---v Date
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OFFICE OFA•THE TOWN CLERK ,C0FOL4 ,
CG
Town of Southold ,&N) '
t y . Application No. 5 ,JLj
Judith T. Terry, Town Clerk <
Town Hall, 53095 Main Road m Construction
P. O. Box 1179 �. 'W
Southold, New York 11971 �,y� Off. Alteration
Telephone ei Ali 0� .� Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. •
Fee $
DATE k2 S -7
APPLICANT NAME: ,j0e-VlC� 1/ -' = / /
APPLICANT ADDRESS: /- !J - 21.-
SEPTIC
ZSEPTIC CESSPOOL C.'
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
aeae / 57)-- ---- 62- ',-
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: /17.‘"A.),5. /2i5-1.}-5/ /
OWNER MAILING ADDRESS: /714i-4/ •4j
`?vd
OWNER PROPERTY ADDRESS: 5,4,,ra /
1 A i ii-&4 -
TELEPHONE NUMBER OF CONTACT PERSON: ,.21k-' 96-rV
TAX MAP NO. : Section /Or Block 9 Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
1/r /
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SignatApplicant a -
RECEIVED BY :
Town Clerk's Office
DATE:
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