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ELIZABETH A.NEVILLE �� *ATown Hall, 53095 Main Road
TOWN CLERK ; $ P.O. Box 1179
os• Aa i Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ® �1
MARRIAGE OFFICER .fo .i Fax (631) 765 6145
RECORDS MANAGEMENT OFFICER -_'"OI too Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2519 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ROBERT RUTKOSKI
Address 1 : PO BOX 1143
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-01-0026
Name Of Owner RUTKOSKI, ROBERT
Mailing Address 1 PO BOX 1143
City St Zip MATTITUCK NY 11952
Property Address 1 ROUTE 48
City St Zip MATTITUCK NY 11952
Tax Map No. section 108.00 block 1 lot 2.000
Cross Street ELIAH'S LANE
Building Permit Number Cross Reference:
Issue Date: 3/02/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OW q
1
ELIZABETH A.NEVILLE � .3� Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
REGISTRAR OF VITAL STATISTICS Z 4?-1 Southold,New York 11971
MARRIAGE OFFICER ® �� Fax Fax(631)765-6145
%RECORDS MANAGEMENT OFFICER ®1 „y��, • Telephone(631)765-1800
FREEDOM OF INFORMATION OFFICER L2
.aptir
OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 21, 2001
Transmitted herewith is a copy of application No. 2607 for a Cesspool/Septic Tank Construction Permit
submitted by:
Robert Rutkoski
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.
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
2) 2z f v 1
Dated
� .
OFFICE OF THE TOWN CLERK 1'����1 FDLK
TOWN OF SOUTHOLD ,�0,� COW‘. Application No.L
6W
Fi J7ABETH A.NEVILLE,TOWN CLERK 0 \
P.O.BOX 1179 _ Construction
SOUTHOLD,NEW YORK 11971 _
Alteration
,,
Telephone 110, t, i'.Q�'i4 • $10.00 -Residential
(631) 765-1800 -=��1 1 $25.00 -Non-Residential
-- ....,,''
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee •$
DATE , -2.1 -O l
CR
("R
APPLICANT NAME: B Ru ( (t.
APPLICANT ADDRESS: ?n, t3\x� 1,1,48
mPccrl iUCC 1 'At. , LetSc. ,
SEPTIC CESSPOOL X
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
) IA) \V wt7-
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONz UCTION OR(A TERATION:
OWNER OF PROPERTY: T ob-E- UTtr1
OWNER MAILING ADDRESS: ?- ,Q, B 114-3
M furl i ,Lt , uR,5)
OWNER PROPERTY ADDRESS:, i,5?
TELEPHONE NUMBER OF CONTACT PERSON: an - °V 6b
TAX MAP NO. : Section `og Block ' Lot a
CROSS STREET: FLS M-k 1 PNE
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signatth-e Applicant
RECEIVED BY:
Town lerk's Office
DATE: c) /
SURVEY OF PROPER*``�r Y, .
51 TUAT : MATTI TUCK
�'�' ENUE----------, TOhl1�l OF SOUTHOW
M6302(OLD MIDDLE ROAD) SUFFOLK GOUT`iTY, 1`LY
8117"e 1 CONCRETE ROADWAY ro
EI=39 317.83
w CERTIFIED TO:
1 ROBERT RUTKOSKI
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SURVEYED OI-29-98
1
1 R,g538 844 BARN LOG. 10-22-98
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PROP. H5E. 12-2S-00
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LOCATION OF 1NELLS 4 SEPTIC6EASTMAINSTREET N.Y S LIC,NO.sceu
RIVERHEAD,N.Y.11901
PROVIDED BY OTHERS 369-8288Fax369-8287 REFERENCE # 98-1�9D
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