HomeMy WebLinkAboutGoros, AlexFROM:
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
IVL~HRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMA~P~ N OFFICER
~' OFFICE OF THE TOWN CLERK
$ ',, Town or SOU,HO .D
TO: SouthOl~Town Building Department
Linda J. Cooper, Southold Town Clerk's Office
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldt own.nor thfork.net
DATED: December 22, 2004
Transmitted herewith is a copy of application No. 3415
Permit submitted by:
for a Cesspool/Septic Tank Construction
Alex Goros
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 beloxv 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 ~
Comments:
DISAPPROVE
Signature
REGtgTi*.AIt O~ VITAL t~TATISTICS
MAP. RIAOI~ OFFK~i~
RECORD~ MANAOEMF-4~r OI~ICF. Jt
FREEDOM OF IN~OPJ~,A~ION OFFICER
F.O. Box 1179
Southold, New York 119/1
~outhol~wn.no~ork~
oF~'ICE OF .TWl~ TOWN CLEBg
· TOWN 'OF SOUTItOLD
SOUTHOLD W,~IIiWAI'ER DI~TRICr
CONSTRUCTION .or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
P. esidentlld~$10 X or Noa-R,~id~nfi~l~$25 .
ALEX GOROS
App~o~n~ M~ Agdres8 201 - 20
23 AVE, BAYS~DE N.Y. 115~Q
S~ptic Ta~.__..or Ow, spool _ _
BfiefD~scdptionofProposed Construciion or All~raiim~ PROPOSED NEW ONE
FAMTLY HOUSE
Locl~ionofPropo~dComln~c~AR~mi0n:
O~=ofProp~y:_ ALEX GOROS
O,wn~Mailin~: 201-20 23 AVE,
BAYSIDE N.Y. 11360
2230 CEDAR DRIVE EAST MARION, N.Y.
11939
(718) 729-4100
Block 05 Lot16
Nsm: md phone numb~ of cc~tsct person
TsxMapNo: 1000 StOlon 022
C~o~ SIl'~l WILLOW DRIVE
NOTE: LOCATION MAY MUST B~. SUBMITI'ED With AFFLICATIO_N,___..I~..W
CONSTRUCHON I~QUIRES SURVI~ ~ HEALTH DEPARTMENT AH'KOVA~
Received b~.~~ ~