HomeMy WebLinkAboutSpiridakis, Tony ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
M~RRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATIO~9~ER
~ ~- ~e3.~-~r-' J/ ~"0FFICE OF THE TOWN CLERK
~X~ ~ m ~ , ,"? ", TOWN OF SOUTHOLD
,
FROM: X~nda 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
southoldtown.nort hfork.net
DATED: July 1, 2005
Transmitted herewith is a copy of application No. 3484
Permit submitted by:
for a Cesspool/Septic Tank Construction
Tony Spiridakis
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 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
Comments:
./
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARKIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATIDN OFFICER
TOVfN OF SOUTHOLD
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential ~ $10 ~//or Non-Residential ~ $25 __
Applicant Name ~?'d"~ ~-Ial ~-t
Applicant Mailing Address ~ 7] eb ]k], /'~'t UI
Septic Tank //or Cesspool '~ ~ ~ ~"
Brief Description of Proposed Construction or Alteration
Town Hall, 53095 Main Road
P.O. Box 1179
$outhold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
Apphcatwn No.~ f6~
Permit No.
Location of Proposed Construction/Alteration:
Owaer of Property: C ~M~.r u..c cd.5' ._)
Owner Mailing Address:
Owner Property Address: ~) ? / 3~ ~ o-.6~ I~3,
lao
Name and phone number of contact person -~-d5 M-[
Tax Map No: Section ff"~ Block
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPAR~'i~J~NT APPROVAL
Signature of Applicant
Date
Received by: '~
5U~VE'f' OP PRO~RTh'
~ITUATI~i
TOJ/~iI
E~TOL~ C~UNTY, NY
SEPTIC, DESIGN BY HICHAEL MAPES P.E.
TES~ ~OLE
I
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NOTES:
0 PIPE FOUND
EDGE OF I",[ETLANDS E~¥ SURVEYOR
ELEVATIONS REFERENCE N~VD '2cI DATUM
PROPERT~ ZONE ~ 40
~RAPHIC 5GALE I"=
JOHN C. EHLERS LAND SURVEYORt
6 EAST MAIN STREET N.Y.S. LIC. NO. 50202
RIVERHEAD, N.Y. 11901
369-8288 Fax 369-8287 REF.\qqp servcr~d%PROS\03-249_LOT_27_3.pro