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HomeMy WebLinkAboutHill ' - ,_l # ' liA,u 09 ELIZABETH A. NEVILLE �11 * Town Hall, 53095 Main Road TOWN CLERK ; y • ; P.O. Box 1179 REGISTRAR OF VITAL STATISTICS PP 1 Southold, New York 11971 MARRIAGE OFFICER "` $"'� 0"�1', Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ®1 ��®�i� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �, � OFFICE OF THE TOWN CLERK SOUTHOLD WOME -( TEI SAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 2632 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : STANLEY SKREZEC • Address 1 : 50 GULL POND LANE City St Zip GREENPORT NY 11944 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 HILL, CHARLES Mailing Address 1 22 HOTEL DRIVE City St Zip WHITE PLAINS NY 10605 Property Address 1 655 LAKE DRIVE City St Zip SOUTHOLD NY 11971 Tax Map No. section 80.00 block 3 lot 20.000 Cross Street , REYDON SHORE DRIVE Building Permit Number Cross Reference: Issue Date: 8/08/01 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) R 9: 3 2____ y I�/�oSufFU`,���i l 1� ®`' t 7 1 �Cf ELIZABETH A. NEVILLE �� 'r' , TowifHall, 53095 Main Road TOWN CLERK o �__ P.O. Box 1179 REGISTRAR OF VITAL STATISTICS : ;1.o rft ,% r ` I ,;_S�uthold, New York 11971 MARRIAGE OFFICERk.e` , -- - Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ;�WO/ ,w`w �# 0.° Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER % so. .....,Is OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: Transmitted herewith is a copy of application No. 2720 for a Cesspool/Septic Tank Construction Permit submitted by: Stanley Skrezec for Charles Hill/655 Lake Dr., Southold 80.-3-20 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: Signaturs,,,,,....„e q/ b . 1 � 1 Dated r w +' rOFFICE OFTHE TOWNCLERK � '��,r�rrrrrirr� TOVVN OF SOUTHOLD U H , ' �7 Rr.rrABETH NEVOWNCLERK ��;� Application No.L/c��FFOLkcOy _- O P.O.BOX 1179 � iO Construction SOUTHOLD,NEW YORK 11971t v • Alteration 7_ Telephone ,�� �Q��' $10.00 -Residential Nt (631) 765-1800 .�l � ,Do' $25.00 -Non-Residential TOWN OF SOUTHOLD • SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. • Fee .$ DATE ,. 1.1 l I © l APPLICANT NAME: ) F. kc APPLICANT ADDRESS: �O t,_(_ ` t),i s Lot4tits— .(2.000rova,1 EY, k ( 4 SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION \N ,N) ©L ..K c NI- J �? �--CQ2 • ' v- ov- v is `Ca Les,os,L k vwz id s G(.e sa SAP S iw s-L_C_ ZA ) Pte-(-k i ,e SSo�L LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: • OWNER OF PROPERTY: 1.41L OWNER MAILING ADDRESS: a o. \\oA-E l_- X12 vcc OWNER PROPERTY ADDRESS: , S• TELEPHONE NUMBER OF CONTACT PERSON: I--r-r7— t TAX MAP NO. : Section .a0 . Block 3 Lot • 2-0 CROSS STREET: 4r)ov� r BUILDING PERMIT NUMBER CROSS REFERENCE: . Sign ture of pplicant RECEIVED BY: 2 Z S1' n Clerk's Office 7 � DATE: / w rI 1 -� izitAb9 1 5-44 0, , 66° rg_m_.25011') s,,ccabsIZN-0 A N m