HomeMy WebLinkAboutTravlos, John (2) ,,� ,o��s�E fOl,'�OG
ELIZABETH A.NEVILLE � _ y� Town Hall,53095 Main Road
TOWN CLERK O P.O. Box 1179
ti
Southold,New York 11971
REGISTRAR,OF VITAL STATISTICS
MARRIAGE OFFICER `. ,fi �����, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ; ! Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER •��,.��� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3196 R Residential X Non-Residential
Fee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : JOHN TRAVLOS
Address 1: PO BOX 511
City St Zip GREENPORT NY 11944
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR ONE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-04-0046
Name Of Owner TRAVLOS, JOHN
Mailing Address 1 PO BOX 511
City St Zip GREENPORT NY 11944
Property Address 1 65 ROCKCOVE COURT
City St Zip GREENPORT NY 11944
Tax Map No. section 33.00 block 3 lot 13.000
Cross Street INLET POND ROAD
Building Permit Number Cross Reference:
Issue Date: 9/01/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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P ELIZABETH A.NEVILLE /�� OGy�! Town Hall,53095 Main Road
TOWN CLERK y • P.O. Box 1179
REGISTRAR.OF VITAL STATISTICS *7"--21
�►► Southold, New York 11971
� �
MARRIAGE OFFICER y � Fax(631) 765-6145
�_
RECORDS MANAGEMENT OFFICER e,� jig .���.,riTelephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,���� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
21
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 21, 2004
Transmitted herewith is a copy of application No. 3337 for a Cesspool/Septic Tank Construction
Permit submitted by:
John Travlos
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:
•
Signature ' (`
aidffe°4 -
Dated
- 1
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OG
IYLIZABETH A. NEVILLE 'I�`L` y�` Town Hall, 53095 Main Road
TOWN CLERK p , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS $ Southold, New York 11971
• MARRIAGE OFFICER G 'F 1Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �IJO a�,• �� Telephone (631) 765-1800
#FREEDOM OF INFORMATION OFFICER - ' * • '' southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 or Non-Residential @ $25 Application No. 3332
Permit No.
Applicant Name -To }-t A/ 1A V L O$
Applicant Mailing Address P.0 , T 1 (
GR. n/ P0R.T N,Y, li 4c5F
Septic Tank or Cesspool ✓
Brief Description of Proposed Construction or Alteration
Nc.‘.4 CoNsTgoer/0A
Location of Proposed Construction/Alteration:
Owner of Property: 'To tJ & ( g•A Y Leg S
Owner Mailing Address: P.O. go $$ S- i j
6 ,ett,NP647. NY /,qip-,/
Owner Property Address: 65- R O Ck Co vi.. Co V T`
gE.E.NPo,eT , NY I/1 se's'
Name and phone number of contact person J pp t�v'/ TA A V40,,S 6 31- V 4a -3'f/
Tax Map No: (001Section b 3, so Block 0;•0 o Lot /3
Cross Street V` (.
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
- 1,1//t4 7L
S gnature of Applicant Date
Received by: -
+ • SURVEY OF PROPERTY
iiii, __ AT GREENPORT
- TOWN OF SOUTHOLD
IJFFO K COUNT Y, N Y.
, ,,' pie I�^ 1O{�'/0-35 OY ,10 3
Drr°"" FEBRUARY 27, 2004
COVET a. _•
yE
.l: ROOK o 000 IThinE
Et-. si
.s A
' _ EXCAV• ION c• S' CTION REQUIRED
F r R SA - TA-Y SYSTEM
1 • BY HEART' Oc- •RT w
*-* _ 0% 3
'4, 1' • V *6'qp• .. _-._..,,, a LOT 1�
• . • .C_ �?' m VACANT
11
t t WO ti ``
tit T .. - .- -
aw SUFFOLK COIR.'"Y DEPARTMENT OF HEALTH SiRVxas
\ � v .
1,` PR :i*: 'CR r'sROV'e.OFCONSTRUCTION FORA
IGL'i,P t:T�i!iiI2SIDENE ONLY
x% � R` ® s,9 •'PROVED // - // LW.I •TES LyO✓MAXI UHSRE".N�BEDR0O-9.
-i0 (
Nn' with the STANDARDS FOR APPROVAL 9 O WY[RES THREE YEARS FROM DATE OF APPROVAL
II) 1 R CF SUBSURFACE SEWAGE o
P'OSAL. SYS,TENS FOR SINGLE FAMILY RESIDENCES
}I t LOT 13 �,
d t abite
con by the conditions set forth therein and on the (;.C2, l ,,
rout to corsSfrucf.
e /ocpt,on of wells and cesspools shown hereon are , Fr
MIT Mid -,yatians and or from data obtained from others. 4i � n
7 .* •
wstkr. , es4dnto an assumed datum. • Q, 11\e
. 34a. azr N87` 59 W =a' �s M,• 490 A
r • 1M$S- V 1$A 1l 138.57 sw.. ;� Fp N V%
�. ,e l ;VW TA tt*I0 110V. int no. O. 4961$
4 .„` S. .t-.At< T* . maws LOT 14
' - -,:; NQ S WNW eft r.r !� CONIC 5141 YG1RS, P.C.
" .;d fi `'r A�*�.SLAL-ti'x411 SGti WYosP VACANT (631) 765-5020 FAX (831) 765-1797 ,
a ,
Lot numbers refer to Rockcove Estates" Med in the Suffolk 1230 TRAVELER STREET
' y BOX 909
County Clerk's Office on .dune 11, 2001 as Frye No. 10637 SO(NIdOLD, N.Y. 11971 04-115
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