HomeMy WebLinkAboutKougentakis, Eleftherios 1°AVSUfFO�,�00G.
JUDITH T.TERRY t$_ y� �� Town Hall, 53095 Main Road
TOWN CLERK C P.O. Box 1179
W r Southold,New York 11971
REGISTRAR OF VITAL STATISTICS � Fax (516) 765-1823
MARRIAGE OFFICER \.** aOs
oft Telephone (516) 765-1800
RECORDS lig
FREEDOM OF NFOR A ION OFFICER •
=AGEMENT OFFICER 1 �,di
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1675 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JAMES E. FITZGERALD JR.
Address 1 : P. O. BOX 617
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-97-0076
Name Of Owner KOUGENTAKIS, ELEFTHERIOS
Mailing Address 1 3808 FILLMORE AVE.
City St Zip BROOKLYN NY 11234
Property Address 1 1155 WINDWARD ROAD
City St Zip ORIENT NY 11957
Tax Map No. section 14.00 block 2 lot 30.002
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 6/02/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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Town Hall, 53095 Main Road
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s � • �` P.O. Box 1179
441 e •ft_/ Southold, New York 11971
JUDITH T.TERRY ��. r' TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 22, 1997
Transmitted herewith is a copy of application No. 1750 for a Cesspool/
Septic Tank Construction Permit submitted by:
James Fitzgerald Jr. for Eleftherios Kougentakis
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.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following reco ndations:
APPROVE
DISAPPROVE
Comments:
RECEIVED
MAY 3 0 1997 gnature
3 ;s'5"
cf3 Js
Southold Town Clerk Dated
OFFICE OF THE TOWN CLERK ""
Town of Southold +C�FFD�xI`O' Application No. /71/4-5--b
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road = Construction '.
P. O. Box 1179 Alteration
Southold, New York 11971
Telephone = ,y . ,'� $10.00 - Residential
(516) 765-1801l
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�' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ f
DATE t� a l /
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APPLICANT NAME: 0 - r- lal
/
APPLICANT ADDRESS: ?CO( � , )�
mikarfx) i\fr (635 .
SEPTIC CESSPOOL
DESHc^R�IPTION 0F PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSiTR� OR� `"� ER �����
OWNER OF PROPERTY: (P ,
OWNER MAILING ADDRESS: WOO 7 f I) 14i
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N PROPERTY ADDRESS:ERP PER SS• i s /ifyivi/'
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TELEPHONE NUMBER OF CONTACT PERSON: 73Cr40
TAX MAP NO. : Sect n Block Lot . 12`•
CROSS STREET: kWh
BUILDING PERMIT NUMBER CROSS REFERENC/E:
of
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Signature f Ap.lic- t
RECEIVED BY:
Town Clerk's Office
DATE:
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