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HomeMy WebLinkAboutKudlinksi • _r a. cs „s„.� FFO�,YOO • \ leELIZABETH A.NEVILLE Town Hall,53095 Main Road TOWN CLERK o P.O. Box 1179 V) Southold,New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER ,f, Fax Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER 4 j -a,iii 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. 3087 R Residential X Non-Residential Fee $ 10.00 Septic x cesspool PERMIT ISSUED TO: Name : MORRIS CESSPOOL Address 1: 2760 YENNECOTT DRIVE City St Zip SOUTHOLD NY 11971 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 INSPECTINO REQUIRED. Name Of Owner KUDLINSKI, E Mailing Address 1 306 CHAMPLIN PLACE City St Zip GREENPORT NY 11944 Property Address 1 306 CHAMPLIN PLACE City St Zip GREENPORT NY 11944 Tax Map No. section 34.00 block 3 lot 39.000 Cross Street Building Permit Number Cross Reference: Issue Date: 9/08/03 Elizabeth A. Neville Southold Town clerk (TOWN SEAL) '91111!"' - ,�®OFFOUr ELIZABETH A.NEVILLE ot i`Z` 4 Town Hall, 53095 Main Road TOWN CLERK d cm, P.O.Box 1179 Southold New York 11971 REGISTRAR OF VITAL STATISTICS ' MARRIAGE OFFICER O �` �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER -.4# ��oie Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER = '� * •' southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $10 /or Non-Residential @ $25 Application No.�2,11 C33-5;51,o0 Permit No. Applicant Name j#®4��S Applicant Mailing Address /6o // C a l"'/ Septic Tank or Cesspool l/ Brief Description of Proposed Construction ot Alteration i - ;i.> Location of Proposed Construction/Alteration: Owner of Property: A...c.,64-10. Owner Mailing Address: ,7d 6 CA - 0.4e,/ ©D 77(,E`Aye - /0/ Owner Property Address: Name and phone number of contact person Tax Map No: Section 5 Block 3 Lot Cross Street NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL 9-.)174Signature of Applicant Date lo 3 Received by: 60 61 1)i