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HomeMy WebLinkAboutGrabowski, Victoria JUDITH T. TERRY ; L Town Hall, 53095 Main Road TOWN CLERK T P.O. Box 1179 REGISTRAR OF VITAL STATISTICS il5 � Southold, New York 11971 MARRIAGE OFFICER VO t� Fax (516) 765-1823 ��� ��' Tel (516) 765-1801 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 776 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : VICTOR GRABOWSKI Address 1 : P. O. BOX 132 City St Zip CUTCHOGUE NY 11935 Descripton of Proposed Construction or Alteration ADDITION OF NEW POOL TO AN EXISTING SYSTEM. APPROVED AS SUBMITTED. EXCAVATION INSPECTION REQUIRED. CALL SOUTHOLD TOWN BUILDING DEPARTMENT (765-1802) FOR AN APPOINTMENT. Name Of Owner GRABOWSKI, VICTORIA Mailing Address 1 P. O. BOX 132 City St Zip CUTCHOGUE NY 11935 Property Address 1 1450 PEQUASH AVENUE City St Zip CUTCHOGUE NY 11935 Tax Map No. section 103.00 block 11 lot 11 .000 Cross Street WILLOW STREET Building Permit Number Cross Reference: Issue Date: 11/19/91 Judith T. Terry Southold Town Clerk (TOWN SEAL) { X 7-4 JUDITH T. TERRY ,�� OL Town Hall, 53095 Main Road TOWN CLERK _ z P.O. Box 1 179 REGISTRAR OF VITAL STATISTICS . �' Southold, New York 11971 MARRIAGE OFFICER y �'��` Fax (516) 765-1823 =_ ; 0 �0��� Telephone (516) 765-1801 a .,...L..,._s +€ 1 is NOV I91991 6 11 OFFICE OF THE TOWN CLERK ` `' ' a! TOWN OF SOUTHOLD i 2. WJ November, 19 1991 To: Southold Town Code Enforcement Officer From: Linda J. Cooper, Southold Town Clerk's Office Transmitted herewith is a copy of application No. A798 for an ALTERATION PERMIT for a cesspool or septic system submitted by Victoria Grabowski 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. 4-(---x-c--t.,___ Linda J. Cooper * * * * * * * * * * * * * I have reviewed the application and location map of the project listed above and make the following recommendation: APPROVE - r/ DISAPPROVE - COMMENTS: aftesu disogio" � ilii�< NOV fSignatu e / 2 117' r j Taw, I 1,__ /ihq/.9( -gm goeukft Date OFFICE OF THE TOWN CLERK ,,,'"""' ''- Town of Southold .�' ,4001./(1)1"-.. 1 r Judith T. Terry, Town Clerk ,t` l/y'; Application No. Town Hall, 53095 Main Road e Construction P. O. Box 1179 Alteration L� Southold, New York 11971 'sirs Telephone 0,��0 0O�1 i� $10.00 - Residential t/ (516) 765-1801 _ 1 l ,, 0 $25.00 -Non-Residential ,,..,,, TOWN OF SOUTHOLD RECEIVED SOUTHOLD WASTEWATER DISPOSAL DISTRICT NOV 191991 APPLICATION Southold Town Clerk for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ DATE ,(� APPLICANT NAME: 16 -1-0 l / t 6 / ] / d `-e-`.54/ APPLICANT ADDRESS: i / 5---) /t:1-q) 45 /Y /�UL SEPTIC CESSPOOL DESCRIPTION OF PROPOS D CONSTRUCTION ORA TERATION a et.,,tAy,,,,.) ce,t LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: `/I c 7 o' 7I4 //e) t S/ '/ OWNER MAILING ADDR 55: , ,`�_ / � ij AV 3 /0 /o' (' OWNER PROPERTY ADDRESS: //..110-t P� f/Al S lc/ 4 v 12— c 2C06 , l7/� TELEPHONE NUMBER OF CONTACT PERSON: "2 3C-/ TAX MAP NO. : Section /c ) 3 Block /( Lot // CROSS STREET: c,e_ y itie_._t BUILDING PERMIT NUMBER CROSS REFERENCE: d( deL/C- Sig ture of Applicant RECEIVED BY: Town Jerk's t'ffice DATE: j i/j ���r� -- ...„- r . : c & () , .7c/ , ,.. .,,,,,.) ,40„ a ¢ v 1 1 j fi J c 1 i 1 1 1 S NOi / f • c( 1 k V) c.L. o 7. (--_________ , _ 30 _ 0,4 1 < _____...„„.,.. o , , , c, 2c/----E _ -, -, ,F 0 / le /qPt iI� ©RC /--/Al ,RID