HomeMy WebLinkAboutZervos, Hedwig ••is°;FFOL4-
ELIZABETH A.NEVILLE ,`` Town Hall, 53095 Main Road
TOWN CLERK p 1 P.O. Box 1179
y Southold, New York 11971
REGISTRAR OF VITAL STATISTICS fvfFax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER y?J01 ���i� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1859 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : HEDWIG & CONSTANTINOS ZERVOS
Address 1 : P. 0. BOX 2035
City St Zip ORIENT NY 11957
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. REF #R10-94-0097
Name Of Owner ZERVOS, HEDWIG & CONSTANTINOS
Mailing Address 1 P. 0. BOX 2035
City St Zip ORIENT NY 11957
Property Address 1 MAIN ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 23.00 block 1 lot 11 .003
Cross Street
Building Permit Number Cross Reference:
Issue Date: 5/11/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
t
es
ELIZABETH A.NEVELLE °,P "0 Town Hall, 53095 Main Road
TOWN CLERK , p C% P.O. Box 1179
ti Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS %0 /11 rrt
MARRIAGE OFFICER 4. Fax (516) 765-1823
1.RECORDS MANAGEMENT OFFICER frU isi ���g
� / Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER 1
' �'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 4, 1998
Transmitted herewith is a copy of application No. 1933 for a Cesspool/
Septic Tank Construction Permit submitted by:
Hedwig & Constantinos Zervos
•
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 re ommendations:
APPROVE
DISAPPROVE
Comments:
ygnatur
5f
4 [ `rqq
Dated
1.
OFFICE OF THE TOWN CLERK �'''��`F!Ik '
TOWN OF SOUTHOLD ,�'Q CSG= Application No. A?
F.I J7ABETH A.NEVILLE,TOWN CLERK 0 'I'1
P.O.BOX 1179 Z Construction
..am SOUTHOLD,NEW YORK 11971
�1 Alteration
Telephone �Q�'� $10.00 - Residential
(516) 765-1801 -_ �l '� ," $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE S 1 IC)
APPLICANT NAME: i VJ U CCAnTAN i I it JO3 Z�r2VOS
APPLICANT ADDRESS: F,o _ Bo X XO35
O R I ct\J i ID k.IC 11q57
J
SEPTIC CESSPOOL .
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
r_ON )CT TIIM) OF NEw NOME 1 alA
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: CO NSTA-NTI 1V bs + 4-1-Ei jt G, ZE RVb
OWNER MAILING ADDRESS: 1>, (:) B0 ( an S
NEW \( ( flq S
OWNER PROPERTY ADDRESS: M,�I N1 RoA-1R T s 2.5
a/ ST M R1ot ) , i�EW lo12K
TELEPHONE NUMBER OF CONTACT PERSON: �a3- 524
Pci ,
TAX MAP NO. : Section (n3 Block l Lot fj j
CROSS STREET: Q c)
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signatu - of Applicant
RECEIVED BY: 4
Town Clerk's fice
DATE: `//9 ZS
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