HomeMy WebLinkAboutMoustakos, George ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
M-&RRIAGE OFFICER
RECORI)S i%iAN.kC-EMENT OFFICER
FREEDOM OF INFOP~LkTION OFFICER
Toxvn Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northforkmet
........ . ' OFFICE OF TI-I~ TOWN CLERK
' · TOWN OF SOUTHOLD
6~;n Bfi~lding Department
Cooper, Southold Town Clerk's Office
DATED: July 30, 2004
Transmitted herewith is a copy of application No. 3359
Permit submitted by:
for a Cesspool/Septic Tank Construction
Liso Construction for George Moustakos
Please review the application and location map and advise if the project has received Suffolk Cou.nty
Health Department ~approval and if this office may issue the permit.
Please complete the form below and remm it to me.
Linda J. Cooper
I have reviewed the application and location map of the project cited above and make the following
recolrmaendations:
. /
APPROVE
DISAPPROVE
Comments
Sigaature ~
Dated
ELIZABETH A. NEVILLE
TOWN CLEI{K
· REGISTRAR OF VITAL STATISTICS
M_A.RRLAGE OFFICER
RECORDS 1VLA.NAGEJVIFaNT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
'Southold~ New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
souiholdtown.nor~hfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTttOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10'~/ or Non-Residential ~ $25 __
Applicant Name
Application No~
PeaTnit No,
Location of Proposed Construction/Alteration:
OwncrofPrope~.. ~ ~- o~r.~,~- ~'~,~
O~Mai~gAd~s: ~ ~
O~Propc~Ad&css: ~ ~' '~ ~
Nameandphonenumberofcontactperson L i:~,~ .~t L~ t~' -
Tax Map No: Section /~ Block O ~ Lot
Cross Street "~ ~ L ¢ ~-f i~>
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NE~r
CONSTRUCTION REQUIRES SURVEY ~rlTH H~ALTH DEPARTMENT APPROVAL
Signatare of Apphcant Date
Received lJy.'~~'