HomeMy WebLinkAboutSzczepankowski ®G
ELIZABETH A.NEVILLE t,ht Town Hall, 53095 Main Road
TOWN CLERK - P.O. Box 1179
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Southold,
REGISTRAR OF VITAL STATISTICS rr►
New York 11971
MARRIAGE OFFICER `\?i, .,. Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER "'/Q %N.Wool 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. 3025 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC 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 SZCZEPANKOWSKI
Mailing Address 1 PO BOX 363
City St Zip CUTCHOGUE NY 11935
Property Address 1 4420 OREGON ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 95.00 block 3 lot 1.000
Cross Street
Building Permit Number cross Reference:
Issue Date: 5/14/03 Elizabeth A. Neville
Southold Town clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE 1���® G.f, Town Hall, 53095 Main Road
TOWN CLERK p P.O.Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS OePri
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER 45b ®' ,� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER %JR/ * 1a.'/ southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
I --
TOWN OF SOUTHOLD
APR 2 2 2003
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 21, 2003
Transmitted herewith is a copy of application No. 3149 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for David Szczepankowski
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 � O"
DV2-8A1
Dated
IP"OFFICE OF THE TOWN CLERK �, Ql/s• CAVOLkc
TOWN OF SOUTHOLD • = Application No. /W
ELIZABETH A.NEVILLE,TOWN CLERK ��
P.O.BOX 1179
Construction
SOUTHOLD,NEW YORK 11971v • rn • Alteration [/
Telephone ff' ® •�• $10.00 - Residential f/
(631;) 765-1800 =��1' �,�•�� $25.00 -Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
1 ' ,
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE /S/G,3
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. O. BOX 972
MATTITUCK, NEW YORK 11952 '
SEPTIC CESSPOOL 13"/
DESCRIPTION_ OF PRO OSED CONSTRUCTION,ORJALTERAl'ION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: r
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OWNER OF PROPERTY: OA z Z &/ k1/k1skI
� .3 63
OWNER MAILING ADDRESS: Rf
OWNER PROPERTY ADDRESS: 44c211 QZ719f7 Q71
TELEPHONE NUMBER OF CONTACT/ PERSON:
TAX MAP NO. : Section C) /CS Block Co 3 Lot ®t
CROSS STREET: -
BUILDING PERMIT NUMBER CROSS REFERENCE:
' :Signature of pplicant
RECEIVED BY: "
Town Clerk's Office
DATE: _ \
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DAVID SZCZEPANKOWSKI
4420 OREGON ROAD
CUTCHOGUE