HomeMy WebLinkAboutPapdopoulos 1 •,�oa S004,--%
ELIZABETHA.NEVILLE , Q Town Hall, 53095 Main Road
TOWN CLERK * 4 P.O. Box 1179
REGISTRAR OF VITAL STATISTICSSouthold,New York 11971
MARRIAGE OFFICER1' Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � I�� 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 ALTERATICti PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3345 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : CHRISTINE RIVERA
Address 1: 250 SOUND BEACH DRIVE
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
SECOND STORY ADDITION
FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT
(631) 852-1400
Name Of Owner PAPDOPOULOS
Mailing Address 1 C/O CHRISTINE RIVERA
250 SOUND BEACH DRIVE
City St Zip MATTITUCK NY 11952
Property Address 1 500 MIRIAM ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 99.00 block 2 lot 9.000
Cross Street INLET DRIVE
Building Permit Number Cross Reference:
Adebff7 ,1,afia
Issue Date: 8/24/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE ,•e 4 „ Town Hall, 53095 Main Road
TOWN CLERK +Jr 4% P.O. Box 1179
REGISTRAR OF VITAL STATISTICS cn ar Southold, New York 11971
MARRIAGE OFFICER `�d �Q A4?”
Telephone
Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER l� '� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER .. COW( southoldtown.northfork.net
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I OFFICE OF THE TOWN CLERK
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FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 2, 2005
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 3495 for a Cesspool/Septic Tank Construction
Permit submitted by:
Christine Rivera for Papadopoulos
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me. Thank you.
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
! 44007 ..
Comments: ,
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Signature
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Dated
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' :
ELIZABETH A.NEVILLE ,ii it Vf ; Town Hall, 53095 Main Road
TOWN CLERK S - % P.O. Box 1179
y, Z 1 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS V. Al
MARRIAGE OFFICER : O '�' 11 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =#1_ 0. oil Telephone (631)765-1800
FREEDOM OF INFORMATION OFFICER ....74e/ * $4:011 southoldtown.northfork.net
OFFICE OF THE TOWN CLERK --
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT •
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
39-75
Residential @$10 or Non-Residential @$25 Application No.
;74,09
Permit No.
Applicant Name ;,/ ,09 �/-�" 't '
Applicant Mailing Address !v i mac-- O)S �� -4"
.,, 777>icrc
Septic Tank or Cesspool /
Brief Description of Proposed Construction or Alteration Z els-,6--/ ,0-...-e- -‘-'
Location of Proposed Construction/Alteration:
Owner of Property: Zel- o --‘Svc' ' s
Owner Mailing Address: c: ,,4,--e-tAt
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Owner Property Address: -6-0c) ..-L, %-n X./..
/1")/I- rr' r“
Name and phone number of contact person Z14/5"z�,- J; ;"j C f fisAP sr-
Tax
Tax Map No: Section %civ Block '7 Lot U 2— r G 7
Cross Street Gc-/
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALT EPARTMENT APPROVAL
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Signature of plicant Date
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SITE PLAN
G/O MIRIAM ROAD 4 INLET DRIVE JEFFREY T. BUTLER, P.E.
MATTI TUCK, NY P.O. BOX 634
' S.G.T.M. # 1000-qq-02-0q SHOREHAM, NEW YORK -
TOWN OF SOUTHOLD COUNTY OF SUFFOLK TEL.: 631.821.8850 FAX: 631.521.72&1