HomeMy WebLinkAboutCaravanos ELIZABETH A. NEVILLE,MMC Town Hall, 53095 Main Road
TOWN CLERK ��� P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631)765-6145
MARRIAGE OFFICER e ` � p�, Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER v www•southoldtownny.gov
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Southold Town Clerk's Office
DATED: February 25, 2021
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4944 for a Cesspool/Septic Tank Construction
Permit submitted by:
Jack Caravanos
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me. Thank you.
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
Signature
Dated
ELIZABETH A.NEVILLE Town Hall, 53095 Main Road
TOWN CLERK @ P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS '
Southold,New York 11971
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER " �" � Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
I
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK f
L/qqqResidential @$1 1 I' r or Non-Residential @$25 Application No.
Permit No.
Applicant darn „_. � .. ” ....
C C,
pp g
A licant Mailin Address �.�,_ ... .. ....... .�.............�
Septic
BriefDes lt�oor Cesspool � L
��✓ �„ ,
� o Proposed Construction or AftcM•atiori
17 0._.... ..m
Location of Proposed C'onstrUCtion/Alteration:
��......e .. ....
.w....._� ._. V� 1Q__ 1
Owner of Propea�y.mm...w....___ �' � 6�d� G�..�' /�°� ..._.__m..... .......�_.�..�IeW 1
Owner Mailing Address:T ------ .. . � '
l
Owner Property Address
Name and phone number of contact person...............a-....���_..._w_...__... _.....................�..... ...�................._.��..........�.._���..
Tax Map No: Section LO...V 0 Block ....��...�. Lot -
Cross Street ._...ew _ ate. .�� .. ..-. �. _ _... . �...., w ��_ �.�. ..........
NOTE: LOCATION MAP MUST BE SU. MITTE WITH APPLICATION. NEW
CONSTRUCTION REQUIRES S ? "'" �H DEPARTMENT APPROV
1,20
Si atm6 of Applicant ate
Received by
Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 02/25/21 Receipt#: 278110
Quantity Transactions Reference Subtotal
1 Septic Permit-Construct- Resid. 4944 $10.00
Total Paid: $10.00
Notes:
Payment Type Amount Paid By
CK#157 $10.00 Caravanos, Jack
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: Caravanos, Jack
137 E 36th St#10A
New York, NY 10016
Clerk ID: JENNIFER Internal ID:4944
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