HomeMy WebLinkAboutDanowski ELIZABETH A.NEVILLE /� ., W hr, Town Hall, 53095 Main Road
TOWN CLERK ® y P.O. Box 1179
, Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS • r - Fax(631) 765-6145
MARRIAGE OFFICER ��
RECORDS MANAGEMENT OFFICER =___® `0,li•g Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ri � southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2715 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PETER DANOWSKI
Address 1 : 604 ROANOKE AVENUE
City St Zip RIVERHEAD NY 11901
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 #R10-01-0191
Name Of Owner DANOWSKI, PETER & SUSAN
Mailing Address 1 604 ROANOKE AVENUE
City St Zip RIVERHEAD NY 11901
Property Address. 1 1625 MONSELL LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 138.00 block 1 lot 14.001
Cross Street SKUNK LANE
Building Permit Number Cross Reference:
Issue Date: 1/11/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ,if 0. " G� Town Hall, 53095 Main Road
r.eTOWN CLERK co - ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER Fax* �1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER -_�®� �4���,;\.,eel Telephone (631) 765-1800
• FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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TO: Southold Town Building Department f
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FROM: Linda J. Cooper, Southold Town Clerk's Office ' '
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DATED: December 28, 2001 TOWN"or'',.ti
Transmitted herewith is a copy of application No. _ 2810 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Peter Donowski
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:
APPROVE17
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
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Signature /
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Dated
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OFFICE OF THE TOWN CLERK �����,/' "••'•••�����
OLD . 401140 nn
FT.WABETHTOA.NEVII.JN OF ,TOWNCLERK 1`��� O7; Application No.v�g/�
P.O.BOX 1179 Construction pe__
SOUTHOLD,NEW YORK 11971 : p T ; Alteration
10.00 -Residential
Telephone
-Wfol $
(631:) 765-1800 =-��1 Jr , ." $25.00 -Non-Residential
. .._,I,,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE / /9-12-&17r)
APPLICANT NAME: Pgi-- g "II�Q�ziC1
APPLICANT ADDRESS: 664 1/-U7€
/t u 4L3) MQI,) (/
SEPTIC CESSPOOL✓
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
F) (2ss e_
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION _OR ALTE TION:
OWNER OF PROPERTY: �� � SUStlki LAA bodGv4t
OWNER MAILING ADDRESS: 6o4 eepokuoa _
OWNER PROPERTY ADDRESS: / ci Mat; )..s /(q-iJ E.
CUT O5O�
TELEPHONE NUMBER OF CONTACT PERSON: 7c 7- 4?O()
TAX MAP NO. : Section i5r Block 0 r Lot /%
CROSS STREET: •Pc�k) � (.4t? a / (4to Lf
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of A icant
RECEIVED BY:
T wn CI k's Office
DATE: / c OK
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r �� � / HEALTH DEPARTMENT CERTIFICATION ~ 1.`�
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