HomeMy WebLinkAboutWoloski „c,00sUFFO`�6' .
ELIZABETH A.NEVILLE ���� 'yam Town Hall, 53095 Main Road
TOWN CLERK o ='� P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS v” s11
Southold, New York 11971
MARRIAGE OFFICER � ,f�,L ���+, Fax(631) 765 6145
RECORDS MANAGEMENT OFFICER VS* �� �i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ���� 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. 3007 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECCONIC CESSPOOL
Address 1: PO BOX 972
City St Zip MATTITUCK NY 11952
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 WOLOSKI, DAN
Mailing Address 1 280 PINE STREET
City St zip MATTITUCK NY 11952
Property Address 1 280 PINE STREET
City St Zip MATTITUCK NY 11952
Tax Map No. section 141.00 block 1 lot 31.000
Cross Street YOUNGS AVENUE
Building Permit Number Cross Reference:
Issue Date: 2/18/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
///ice,
,_ �,,��S11FF0`,�-c. �� 7
ELIZABETH A. NEVILLE ���h`1�� ®Gy
d � Town Hall, 53095 Main Road
TOWN CLERK % o % P.O.Box 1179
% h Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 1
MARRIAGE OFFICER " ,f, Fax Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER --_�
__ ®1 jlig �ao 1i Telephone (631) 765-1800
FREEDOM OF IN FORMATION'OFFICER _ /������ southoldtown.northfork.net
Fr - :11 :_ _,' '
OFFICE OF THE TOWN CLERK
FEB1 2 1 TOWN OF SOUTHOLD
,, rl ,
LTQ:• .'-?'==- - Southoll"T�wn Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 12, 2003
Transmitted herewith is a copy of application No. 3130 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Don Woloski
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. .
rpt1/4;‘,";ii..1_,)
Signature
0•1--A--/43
Dated
I ' c - . ' . 1 0 ,-, ,
I
OFFICE
OF THE
OF 60 OWN CLE 0.. •.
11 \`V JJj • '
COG _ Application No:3/33
ELIZABETH A.NEVILLE,TOWN CLERK -• � �'
P.O.BOR 11791- .`,F • Construction ,
SOUTHOLD,NEW YORK 11971 0 rn i
Alteration
Telephone ,;:IJ:,.®�, .Q�.•-, ' $10.00• - Residential '
i
(631) 765-1800 (l' *�;,i" $25.00 -Non-Residential
' .•ilii
TOWN OF SOUTHOLD -
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$ -
DATE 77�®3
APPLICANT NAME: PECONIC CESSPOOL •
APPLICANT ADDRESS: P. O. BOX 972
MATTITUCK, NEW YORK 11952'
SEPTIC CESSPOOL—
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
_.�_/i—..-» /.i La. 1 !a-_
•
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
. OWNER OF PROPERTY: C aides f, ,
OWNER= MAILING ADDRESS: o9810 /1 n
' OWNER PROPERTY ADDRESS: �l�n..e- ,
TELEPHONE NUMBER OF CONTACT PERSON:c9-1Y="965-7
TAX MAP NO. : Section 1W Block / Lot /
CROSS STREET: •„.V', ,-c,
BUILDING PERMIT NUMBER CROSS REFERENCE: .
, /k-
' Signature of .•pplicant
RECEIVED BY: �--- '
Town C erk's Off €,:e•
DATE: 2-/((70 3 •
- .--\, . .
\\
t \
L
Wil! '.,��"�
eJ :1 :.0° L
if - 14.6„....., ____v_i\\\
bug,„:7'1, .;54.. .,, ..f.,—.
`\4.3
\o„ (a-5-7?-ov 6
Dan Woloski
280 Pine Street
Mattituck