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ELIZABETH A.NEVILLE �,' 4 Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
ti 2 �
Southold New York 11971
REGISTRAR,OF VITAL STATISTICS %
MARRIAGE OFFICER ` ?,iLQl �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER - `'/ S iii Telephone (631) 765-1800
411
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. 3035 R Residential X Non-Residential
Fee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : AGNIESZKA DROZDOWSKA
Address 1: 13405 MAIN ROAD
City St Zip MATTITUCK NY 11952
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 #R10-02-0242
Name of Owner SWING, ROBERT & CELIA
Mailing Address 1 28 DYKE ROAD
City St Zip SETAUKET NY 11733
Property Address 1 445 ISLAND VIEW DRIVE
City St Zip GREENPORT NY 11944
Tax Map No. section 57.00 block 2 lot 27.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 6/11/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
00 ; 3 0 35
ELIZABETH A.NEVJLLE ��_� 4 Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
y = ' Southold,New York 11971
REGISTRAR OF VITAL STATISTICS V6 71�
MARRIAGE OFFICER
` Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER y_'J1pl �a��ii�1 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ��'� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department ;
MAt 8 201
FROM: Linda J. Cooper, Southold Town Clerk's Office
BLD'
DATED: May 8, 2003 i
Transmitted herewith is a copy of application No. 3159 for a Cesspool/Septic Tank Construction
Permit submitted by:
Agnieszka Drozdowska
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 1 cation map of the project cited above and make the following
recommendations:
APPROVE
•
DISAPPROVE
Comments: .mac..
Signature
051/3/0.3
Dated
�h
OFFICE OF THE TOWN CLERK ' 1r
iC�cC01 r
TOWN OF SOUTHOLD '•O' `{ 6
Application No.31
ELIZABETH A.NEVA LF,TOWN CLERK 1 �� p p
P.O.BOX 1179 % Construction
SOUTHOLD,NEW YORK 11971v T
Alteration
Telephone V° $10.00
�Q�i
, $10.00 -Residential
(516) 765-1801 _ ! ,,!'� $25.00 -Non-Residential
.,.,,,,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 'M P'\-1
APPLICANT NAME: ISCA21 -.)4 DY2-402:00(,ADS14-2} •
APPLICANT ADDRESS: 1nbL-iQ 5 MA-( Ili „e_j; •
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION 6.
to G L0 Duo r✓0U0 P t -6E 0.. S i I & 6156
QTc
DiAVkill�Cr,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ROI-66?--=r" -9 CE/\1J1 Std I tLDG- .
OWNER MAILING ADDRESS: 8 D' l✓ )DA-1>,
fit✓T 1 lLG i k `-I . W7
OWNER PROPERTY ADDRESS: /41-i 5• I�Lc�-� 1� \ReAA..) DeAuE,
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 5/ Block 002. Lot on
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
Pi pUte5`T4A-8\ Di/0/.01,060Cdte\.
' Signature of Applicant
RECEIVED BY
411111h. I_p _I
• n 'Clerk's Office •
DATE: 5/Y 5
otwe/%, atwe%7� ocwe/%ay SC..DHS Rel.# RIO-01-0242
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I Lo41�►y e/59 GROUND WATER HIGHEST EXPECTED
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3 B' Mgr h Drowna P� __ 6-9000-$jlimy ,
• Slily Sand SAI „No29/.24'
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Order k Pale ‘, LEAG1WG POOLS TO 2 FT.
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GRED
SURVEY OF PROPERTY
AT ARSHAMOMOOUE
• TOWN OF SOUTHOLD
SUFFOLK COUNTY, NY.
1000 - 57 - 02 - 27
SCALE 1" = 30'
OCT. 20, 1999 ,
June /3, 2000 (addition)
•
SEPT. 21, 2001 ( prop. additions 1
oG r 3► tool (s e p / c. system )
Nov. 13, 2001 (additions)
• Feb. l 4,2002
EL EVA TIONS ARE REFERENCED TO N.G.V.D.
• FLOOD ZONE FROM .( ._OV N f
36/0300/59 G MAY 4, 1998 '\�� ft,,
c7 �a t. MFrZ'n -et.
AREA = 17,912 sq ft t® tie line t.
r3 4
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION • �'
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. j / l/ :,
EXCEPT AS PER SECTION 7209 - SUBDIVISION 2. ALL CERT1FICAT1oaS \ --1,g 0.41' N. Y.S. LIC. NO. 49618
HEREON ARE VALE! FOR THIS MAP ANO COPIES THEREOF ONLY IFa � .v
-I SAID MAP CR COPES BEAR THE S PRESSED SEAL OF THE SURVEYOR . �.-, 11,4 1.`-= , P.C.
WHOSE SIGNATURE APPEARS HEREON. I; � ";"4 ---40,?.'`` AX (631) 765 - 1797
.�
AB:ITIORALLY TO COMPLY WITH SAID LAW TIE ' a'ALTERED BY' P, ;$'• Ds)._..--.
MUST BE USED BY ANY AND ALL SURVEYORS UT A COPY 1230 ' - •`' R STREET
OF ANOTHER SURVEYOR'S MAP. TERMS SUCH AS 1'VSPEC7ED°ANDBROUGHT-TO-DA -ARE NOT W COMPLIANCE WITH THE LAIC SOUTHOLD, N.Y. 11971
.
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