HomeMy WebLinkAboutMangles, George . ____ N ,e" -------,
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ELIZABETH A.NEVILLE I_ t\ Town Hall, 53095 Main Road
TOWN CLERK o - • P.O. Box 1179
% Southold, New York 11971
REGISTRAR OF VITAL STATISTICS V '�
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER `=y_ Q! /a- i��, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER •8
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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. 2824 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : GEORGE MANGLES
Address 1 : 255 WEST LANE
City St Zip EAST MARION NY 11939
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner MANGLES, GEORGE
Mailing Address 1 255 WEST LANE
City St Zip EAST MARION NY 11939
Property Address 1 255 WEST LANE
City St Zip EAST MARION NY 11939
Tax Map No. section 38.00 block 6 lot 1 .000
Cross Street NORTH LANE
Building Permit Number Cross Reference:
Issue Date: 6/21/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
l ell OF� OF a g .yt
ELIZABETH A. NEVILLE e_ y�; Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
W I $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS `0 !'V. 0 Fax(631) 765-6145
MARRIAGE OFFICER ,L
RECORDS MANAGEMENT OFFICER ___7Q14. 4)„, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ���� southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
, ,w 242002
TO: Southold Town Building Department
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FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 23, 2002
Transmitted herewith is a copy of application No. 2926 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Stanley Skrezec
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.
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings, property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED. .
Signature
d'L
Dated
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OFFICE OF THE TOWN CLERK C.OFO(,r
TOWNOFSOUTHOLD S
COIj Application No. I d0
ELIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential l
P.O.BOX 1179 to fzi
$25.00 - Non-Residential
SOUTHOLD,NEWYORK 11971 1�
Telephone 40 * Y► �'
•
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
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SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $
DATE S _
1 o2-
OWNER NAME: Pt1 ., A// �^ s
OWNER MAILING ADDRESS: 4„2,_. Cr.-- A.Zej7 i�,tre
,4---AM- _s 7 "7/ old,
OWNER PROPERTY ADDRESS: �ile2/ L,-47f /,r -
OWNER TELEPHONE NUMBER: '/ 77 -- Q 62-J
TAX MAP NO. : Section as Block +O Lot
CROSS STREET: kcly j l4 Lon+4r—
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool G/ New ✓ . Existing
Residential •,/ Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
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S'gnature f Applicant
RECEIVED BY: k__ •
own Clerk's Office
DATE: )•`C 0r)--
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