HomeMy WebLinkAboutGalomis, George o�oSufFot�.�QG
ELIZABETH A.NEVILLE �.� y Town Hall, 53095 Main Road
TOWN CLERK h P.O. Box 1179
REGISTRAR.OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICERFax(631) 765-6145
RECORDS MANAGEMENT OFFICER y�Qjogl �aO� 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. 3221 R Residential x Non-Residential
Yee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1: PO BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTINO REQUIRED.
Name Of Owner GALOMIS, GEORGE
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Mailing Address 1 28-19 35TH STREET
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City St Zip ASTORIA NY 11103
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Property Address 1 38530 COUNTY ROAD 48
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City St zip GREENPORT NY 11944
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Tax Map No. section 33.00 block 5 lot 21.000
------ --- ------
Cross Street MC CANN LANE
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Building Permit Number Cross Reference:
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Issue Date: 9/02/04 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
1
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ELIZABETH A. NEVILLE y Town Hall, 53095 Main Road
TOWN CLERK H Z P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS O Southold, New York 11971
-6145
RECORDS MARRIAGE F
Fax
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ANAG MENT OFFICERP
FICER y��' �aO�� Tele hon5
Telephone (63 6765 1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 9, 2004
Transmitted herewith is a copy of application No. 3362 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for George Galanis
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.
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signature
_ a
�o �7
Dated
OFnc8OFUMTOWN CLUK vu A p plication No.'✓ 3( Z
TOWN OF SOUTHOLD OGo I I
EUZA13MIA.NBV1t1J3.TOWN CLLRK Cutlstruct (�
P.O.BOX 1179
SOU171o[1),NE?W YORK 11971 p T to ra tion
Q � ��
Telephone $IU.UI) - Resi elft al
`a
(531) 765-1800 � $25.UU - Non-Residential
TOWN OF SOUTHOLD
SOUTIIOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ DATL
APPLICANT NAME: PECON1C CESSPOOL
APPLICANT ADDRESS: P. O . BOX 972
MATTITUCK , NEW YORK 119 "Z J f
SEPTIC CESSPOOL 1/
DESCItIPTiONF PROPOSED CONSTRUCTION OR AL:2A
LIZA I IOIJ
LOCATION MAP: Must be attached hereto before Kermit may be issued.
LOCATION OF PROPOSED CONSTRUC"1 N OR l'ERAT10N :
OWNER OF PROPERTY:_-?GC/� - -----
OWNER MAILING ADDRESS: Q2�•-!�j, 3� �_ _ _____
OWNER PROPERTY ADDRESS: !� (o�'S3� —"' � ejy
TELEPHONE NUMBER C'= CONTACT PERSON :
TAX MAP NO. : Section 3 —.Block---�----Lot---�r- ----
CROSS STREET: _2?jL
BUILDING PERMIT 14U OBER CROSS REFERENCE :
Signature of Aj l)H ant
RECEIVED I3Y:
own wlc s Of�lce
DATE: G a
George Galanis
is 5 Madison
Greenport
AliPI-1 pet
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 08/09/04 Receipt#: 8130
Transaction(s): Subtotal
1 Septic Permit- Construct- Resid. $10.00
Check#: 8130 Total Paid: $10.00
Name: Peconic, Cesspool
P O Box 972
Mattituck, NY 11952
Clerk ID: LINDAC Internal ID:99303