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ELIZABETH A. NEVILLE ,`�� Gy s Town Hall, 53095 Main Road
TOWN CLERK p 4 P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
411 MARRIAGE OFFICER �Oy 1Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER �01 , Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICERYr
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 18811. R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ZOUMAS CONTRACTING CORP.
Address 1 : 18 DEERFIELD DRIVE
City St Zip WADING RIVER NY 11792
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.
Name Of Owner ZOUMAS CONTRACTING CORP.
Mailing Address 1 18 DEERFIELD DRIVE
City St Zip WADING RIVER NY 11792
Property Address 1 PECONIC BAY BLVD.
City St Zip LAUREL NY 11948
Tax Map No. section 109.00 block 2 lot 12.005
Cross Street CROWN LAND LANE
Building Permit Number Cross Reference:
Issue Date: 7/10/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE �$h� yam►•�` Town Hall, 53095 Main Road
TOWN CLERK ; cD -� P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % %%0, Pry t, Southold, New York 11971
MARRIAGE OFFICER y � 1� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER �Q � � Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER 41( ,6��i�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 15, 1998
Transmitted herewith is a copy of application No. 1958 for a Cesspool/
Septic Tank Construction Permit submitted by:
Zoumas Contracting Corp.
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.
ce
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE /.
DISAPPROVE
Comments:
'gnature�
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Dated
OFFICE OF THE TOWN[CLERK '',,�UFFOtI�I' /9„?'
TOWN OFSOUTHOLD ;' Ql/= Application No.ELIZABETH A.NEVI LE,TOWN CLERK
P.O.BOX/4179 0 !4Construction ✓
SOUTHOLD,NEW YORK 11971 . = Z
s vi ri,) Alteration
Telephone 04 kV $10.00 - Residential ✓
(516) 765-1801 = 01 I,,'' $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 WZ/9/
APPLICANT NAME: ZV01, - �n,r lc-riNG. ai p
APPLICANT ADDRESS: 1 g .Q-12( 6 L O .alt vim..
rP 4D (AJ G Pc L/.eA, /v-y • / 17 9 --z-
SEPTIC
SEPTIC / CESSPOOL
DESCRIPTION OF PROPOSED CONST'' CTION OR ALTERATION
IIRA . 2n /, . / -
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: A-/4/16-
OWNER
6`OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: got 9 -/. 7O
TAX MAP NO. : Section 109' Block Lot /GI,
CROSS STREET: C{ZpwAJ LANG LANE--
BUILDING
PERMIT NUMBER CROSS REFERENCE:
, C __
ION OF PR •O •licant
RECEIVED BY: �"
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T w Clerk's Office
DATE: (to /( "1.-- 7
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SURVEY OF PROPERTY O� &_< I.
AT LAUREL s- /,��' i.
TOWN OF SOUTHOLD �� !;
SUFFOK COUNTY, N Y. �m /
1000 - 126 - 11 - 16 -� �! J ,..- y
Scale: 1" = 30' 042�e Q'
May 29, 1998
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./(A►1E' 10, 1998 (certification) w
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CERTIFIED TO' O
TOPAZ ABSTRACT CORP. ,,3"�.# G
FIRST AMERICAN TITLE INSURANCE ,\� ��
COMPANY OF NEW YORK / / 21
JOSEPH BAJADA °\ / .- �q,
LORRAINE H. WOLF
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AREA = 30,199 sq.ft. to tie line ��.\E Of NE*ko
S o‘„,,,,I MErZ� ,./:,
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION
" 3,7W 1'
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW, * T+s \,:..�i'.-'i
EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS / ,1,
HEREON ARE VALID FOR THIS MAP AND COPES THEREOF ONLY F I .; ��I'
SAID MAP OR COPES BEAR THE IMPRESSED SEAL OF THE SURVEYOR �,• " At? -, Q1V .S. L/C. NO. 49618
WHOSE SIGNATURE APPEARS HEREON. atimir`.
ADDITIONALLY TO COMPLY WITH SAID LAW THE TERM "ALTERED BY' P. ® 7 ����r , P•C.
MUST BE USED BY ANY AND ALL SURVEYORS UTILIZING A COPY (5I. "'N 1 �•or
OF ANOTHER SURVEYOR'S MAP. TERMS SUCH AS INSPECTED' AMD P. 0. '• '
`BROUGHT-TO-DATE' ARE NOT IN COMPLIANCE WITH THE LAW. 1230 TRAVELER STREET
SOUTHOLD, N.Y. 11971
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98 - 203