HomeMy WebLinkAboutBrodrick ®NoSVFFoc,�4,
_ ELIZABETH A.NEVILLE ,�� Town Hall, 53095 Main Road
TOWN CLERK z o % P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS v� i Southold,New York 11971
MARRIAGE OFFICER � 1i es�, _ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER j �a®�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. 3101 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : STANLEY SKREZEC
Address 1: 50 GULL POND LANE
City St Zip GREENPORT NY 11944
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 BRODRICK, JUDY
Mailing Address .1 2585 SOUTH HARBOR ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 3715 SOUTH HARBOR ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 3 lot 66.000
Cross Street HIAWATHA'S PATH
Building Permit Number Cross Reference:
Issue Date: 10/20/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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,1° COG-, C.31( 01
ELIZABETH A.NEVILLE eh� 'y Town all, 53095 Main Road
TOWN CLERK o i4 I P.O.Box 1179
ti a ' Southold,New York 11971
REGISTRAR OF VITAL STATISTICS V '
`� $ Fax(631) 765-6145
MARRIAGE OFFICER :. ejiL �01
RECORDS MANAGEMENT OFFICER �_"ryo, , ,, Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER ,s" southoldtown.northfork.net
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' L, -
OFFICE OF THE TOWN CLERK
' SEP 3 0 2003 TOWN OF SOUTHOLD
T O: i -'-Southold Town Building Department
artment
,.._
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: - September 30, 2003
Transmitted herewith is a copy of application No. 3239 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Stanley Skrezec-For Judy Broderick
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 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.
j_____ 5/___ --
Signature
£e :L /, .
Dated
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OFFICE OF THE TOWN CLERK ,,,,,,,,.
Town of„Southold ,''��c�Ffll(K =
�� 4V ��G - Application No. 3?
Judith T. Terry, Town Clerk �,0 y
Town Hall, 53095 Main Road Z ;� . Construction ✓
P. O. Box 1179 • c Alteration
Southold, New York 11971 ;to rn�;
Telephone ; 0 .0.-/ $10.00 - Residential
(516) 765-1801 =.�1 4 �,, $25.00 -Non-Residential
-• .. .,1 /,' to
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT ,
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. ” , .
Fee •$
DATE Seri w.( 7 1/4-r Za
APPLICANT NAME: �`:X4\1 1 N<'ezeC—'
APPLICANT ADDRESS: S-0 G•-k.;LA.- ?c)-^D `4 .'tr
0
SEPTIC CESSPOOL '\ J
DESCRIPTION OF PROPOSED CONSTRUCTION OR kt,-0
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION,: ',
OWNER OF PROPERTY: . JLI C\t 3r v-
OWNER MAILING ADDRESS: c 17 • . NiNc•boy- Q ,
OWNER PROPERTY ADDRESS: 4kykn.4e --A3 oy-
TELEPHONE NUMBER OF CONTACT PERSON: kti ^ t s--'LZ
TAX MAP NO. : Section 1 Block 3 'Lot 6 Ca ,
3
CROSS STREET: l (1/4..n/A"" t,'1/4 5 Q, ry , ;
BUILDING PERMIT NUMBER CROSS REFERENCE:
,
4
1 r's
.' _ - a Sig ature of pplicant
- 4 ',A7-
RECEIVED BY:
Town Clerk's Office
DATE: (1, 2A )
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