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ELIZABETH A. NEVILLE / rt 1 Town Hall, 53095 Main Road
TOWN CLERK i P.O.Box 1179
y, Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS ; G �` �� Fax(631) 765-6145
MARRIAGE OFFICER ti `. II
RECORDS MANAGEMENT OFFICER � �®1 jig $'ii• Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER to southoldtown.northfork.net
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OFFICETTOF THE
��TOWN
LLDDCLERK
SOUTHOLD WAGS WATERUDISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2917 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 INSPECTION REQUIRED.
Name Of Owner JAEGER, PATRICIA
Mailing Address 1 420 MILL CREEK DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 420 MILL CREEK DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 135.00 block 3 lot 45.000
Cross Street GROVE ROAD
Building Permit Number Cross Reference:
Issue Date: 10/30/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
011.4#1 00*), O� 1 1
ELIZABETH A.NEVILLE ��1 a# OTown Hall, 53095 Main Road
TOWN CLERK % P.O. Box 1179
Southold,eta
REGISTRAR OF VITAL STATISTICS
New York 11971
MARRIAGE OFFICER Fax,y l��1�1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �_�Ql 1b iii Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER ,,�� southoldtown.northfork.net
II ^'ry
OFFICE OF THE TOWN CLERK
`, OC 0 2002. ;; TOWN OF SOUTHOLD
TO: r=1 SotithplcLTown Building Department
S
TOWS! s s Vii;.11. )(_ D
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 10, 2002
Transmitted herewith is a copy of application No. 3036 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Stanley Skrezec
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.
Gv'
Signature
/o/de/2_
Dated
7 t'
OFFICE OF THE TOWN CLERK ��'J
'x p'Town of. Southold - ,''. ��FWire,"= 7
Application No.-
Judith T. Terry, Town Clerk $ O�
Town Hall, 53095 Main Road . Construction •
P. O. Box 1179
�*' ; Alteratio t..�
Southold, New York 11971 fn. ��
V+ �0* 0 $10.00 - Residential
Tele hone
(516) 765-1801 - Q� � �,,•• $25.00 - Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ •
DATE ® O b er' G / 2®c -
APPLICANT NAME: . L\/ SCC-i2-6.2,6Z—
APPLICANT
CISAPPLICANT ADDRESS:
C;-67 - t c.--5
SEPTIC CESSPOOL /1)(E- ,
DESCRIPTION OF PROPOSD CONSTRUCTION OR ALTERATION iffkt .6 .
Q art C--km C' )O 1_ $ i . 4.0 t
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER- OF PROPERTY: y `�'I�Gv
OWNER MAILING ADDRESS: • •Serpa 4-S
OWNER PROPERTY ADDRESS: t o L 4, 1♦ '- Vt
• b-.)7)-1&01--b 1 ►U V-
TELEPHONE NUMBER OF CONTACT PERSON: 4-7 -
TAX MAP NO. : Section 1A Bldck 3 Lot Li `,
CROSS STREET: (/1_civE 4c
BUILDING PERMIT NUMBER CROSS REFERENCE:
Sii.natu e of Applicant
RECEIVED BY:: AI
jr2 Clerk's Office
DATE: I�
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