HomeMy WebLinkAboutWolzcok - I '
c fFO(,�-c
ELIZABETH A.NEVILLE Town Hall, 53095 Main Road
TOWN CLERK d P.O. Box 1179
REGISTRAR OF VITAL STATISTICS :` /,i, Southold, New York 11971
MARRIAGE OFFICER ``y o a0.•• TelephoFax ne (63 31) 765-6145
5765-800
RECORDS MANAGEMENT OFFICER __1
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. 3033 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
REPLACE EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner WOLZCOK, JOHN
Mailing Address 1 32 SIXTH AVENUE
City St Zip FARMINGDALE NY 11735
Property Address 1 1880 SIGSBEE ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 114.00 block 1 lot 13.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 6/11/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
os,,��®SofFo�,��; 3o33
ELIZABETH A.NEVILLE ��_ OGyd Town Hall, 53095 Main Road
•
TOWN CLERK o - P.O. Box 1179
ti Southold,New York 11971
REGISTRAR.OF VITAL STATISTICS
MARRIAGE OFFICER ` ,y ��es Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER "'/Ql , S,, Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFTCER _ ,.'� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
i ' ' MAY 2 A114 TOWN OF SOUTHOLD
tt` ;<< av,
Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 1, 2003
Transmitted herewith is a copy of application No. 3157 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for John Wolzcok
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.
,421 )
Signature
//7/-de,. /7 2Do 3
Dated
I
OFFICE OF THE TOWN CLERK ,,� s '��i�'z...,y�� cl
TOWN OF SOUTHOLD �,��e'Jo�kCt:"*.
=
JOHN WOLZCOK
1880 SIGSBEE ROAD
MATTI TUC%
•
. 5+ A) 1
I
r
k
i�' AL
eS TT ki..„.... , ,sc, ,
i , LII
IL----------
ti�5t $ id
�1LT___.-vt)
. St�r;h-4/
i, ii;1 '&k