HomeMy WebLinkAboutZoumas Contr (2) ELIZABETH A. NEV~ TOWN CLERK
REGISTRAR OF ~ITAL STATISTICS
MARRIAGE OFFICER
RECOP. DS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
[TO: ., ~?;~¢,-~ Building Department
FROM: Linda J. Cooper, 8onthold Town Clerk's Office
OFFICE OF TI-I~ TOWN CLERK
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P,O~ Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldto~m.northfork.net
DATED: August 3; 2004
Transmitted herewith is a copy of application No. 3361 for a Cesspool/Septic Tank Construction
Permit submitted by:
Zoumas Contr~. Corp. for Stephen Mishoven
Please review the application and location map and advise if the project has received Suffolk County
Health Depar~ent 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
Signature
Dated
ELIZABETH A. NEV'~,LE
TOWN CLERK
REGISTKAR OF ',fITAL STATISTICS
M-Z~RIAGE OFFICER
RECORDS MANAGEMENT OFFICEH
FREEDOM OF XNI7OtkM~TION OFFICER
To~n Hall, 53095 Maffn Road
P.O. Box 1179
Southold, New York L1971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtowm nor~b~ork.net
OFFICE OF TI-I~ TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD ~VASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10
Applicant Name
Applicant Mailing Address
__ or Non-Residential.~ $25 __
Application No. 3~/
Permit No.
Septic Tank_.~_or Cesspool
Brief Desertion of Proposed Construction or Alteration
Location of Proposed Construction/Alteration: Owner of Property: ~ ~,'
Owner Mailing Address: ~ 7 0 f ~/~,,~ vid 0 ~ & ~/~.~
Owner Property Address: 0 ¢/5 0 g~c .~-'~rtt. O ~-~
Name and phone number of contact person
Tax Map No: Section ~ / Block E) 7 Lot / 7
rossS eet
NOTE: LOCATION MAP MUST BE SUBMITTED ~ APPLICATION. NEW
~ of Applicant'~::~ Date ' /
Received l~y: