HomeMy WebLinkAboutElisseou, Evan ELIZABETH A. NEVILLE
TOWN CLERK .
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS I~LkNAGEIIVEE N T.. OFFICER
!~FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOVfN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldt own. nortkfork.ne~
TO:
FROM:
DATED:
RE:
Sonthold Town Building Department
Linda J. Cooper, Southold Tox~ Clerk's Office
June 29, 2004
Cesspool Construction Application
Transmitted here~4th is a copy of application No. 3341
Permit submitted by:
Young & Young for Evan Elisseou
for a Cesspool/Septic Tank Construction
Please review tlie a~plkation and location map and advise if tkis 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 aud make the following
recommendations:
APPROVE /
DISAPPROVE
Comments:
Signature
Dated
ELIZABETIi A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARKIAGI~I OFFICER
' i~ECORDS MANAGEM~Cr OFFICER
FREEDOM OF rN'FORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-18g0
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTE%VATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10
Applicant Name
X or Non-Residential ~ $25 __
Robert C. Tast
ipp icatio. No. 35 /
Permit No.
AppScantMaiing Address Young & Young 400 Ostrander Avenue
Riverhead, New York 11901
Septic Tank x or.Cesspool x
Brief Description of Proposed Conslruction or Alteration
system for proposed two story house.
New ~onstruction of sanitary
Location ofProposed Construction/Akeration:
OwnerofProperty[ EVan Elisseou
OwllerM~lingAddress: 730 Hudson Street,' Apt. 4
Hoboken, New Jersey 07030
Owncr Property Address:_ Lot 128, Zena Road & Central Driv~
Mattituck, New YOrk 11952
Name m~d phone number of contact person
Robert C. Tast (631) 727-2303
Tax Map No: ' Section 106 . Block ~ 02 Lot 33
Cross Street zend Road
NOTE: LOCATION I~IA.P MUST ~E SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SUR¥1E¥ ~7. l~I HEALTH DEPARTMENT APPROVAL
' [~ May 17, 2004
Sigitature of Applicant Date
Received 6y: 2'~ ~ ~/~_~/a~,~
95.(
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