HomeMy WebLinkAboutKoustantakas, Katy • I _,/ ilii �
1�.0, SOF soil fol _\
ELIZABETH A. NEVILLE d '` O Town Hall, 53095 Main Road
TOWN CLERK * * P.O. Box 1179
� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS cn
r) @
MARRIAGE OFFICER . ,� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER :fly`►QUry�',�V t. Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ' 06 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. 3403 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PETER DENICOLA
Address 1: 1695 CHABLIS PATH
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
-NEW CONSTRUCTION, BOARD OF HEALT SETUP
Name Of Owner KATY & KOSTAS KOUSTANTAKAS
Mailing Address 1 58 WALNUT STREET
City St Zip TEANECK NJ 0000
Property Address 1 CHABLIS PATH
City St Zip SOUTHOLD NY 11971
Tax Map No. section 51.00 block 3 lot 3.500
Cross Street CHARDONNAY DRIVE
Building Permit Number Cross Reference:
Issue Date: 2/01/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
1
,, ..-
�,�%OF SO(/liv, -
ELIZABETH A.NEVILLE l0 Town Hall, 53095 Main Road
TOWN CLERK ; iligl , P.O. Box 1179
N
REGISTRAR,OF VITAL STATISTICS Southold, New York 11971
G � ,�
MARRIAGE OFFICER �O e1 Fax (631) 765-6145
r _,,.___BFCORRS MANAGEMENT OFFICEROIp°, Telephone (631) 765-1800
R {E 11JOM OF INF C INFORMATION OFFICER DUn 1 i,0.0
southoldtown.northfork.net
t
6 orPOFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 3556 for a Cesspool/Septic Tank Construction or
Alteration Permit submitted by:
Peter Denicola
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
Daty(c/L
• �/4,SUFFO(iv
ELIZABETH A.NEVILLE ; �'�` ��; Town Hall, 53095 Main Road
TOWN CLERK J P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �ft � Southold, New York 11971
MARRIAGE OFFICER :t. '��1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ‘...#0# a��iilTelephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - 1 * '�.� 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 @$25 Application ► _�
Permit N.. <z
Applicant Name �� N1 Ctac
Applicant Mailing Address i(o C.S C,1^4 61.;S st.4
SQu4-(..oL, , P`1 l C 13 i
Septic Tank f or Cesspool ✓'
Brief Description of Proposed Construction or/Alteration
deaf C4h q¢2 ,1 1. • � or'. H 304,40 '( 54P
Location of Proposed Construction/Alteration:
Owner of Property: t(a1-/ . )(e -I0'5 14014- Sift 1-444$
Owner Mailing Address: C$ W'-L r.c.4 St
(P,p, ' -ede. , t`ty
Owner Property Address: 4 6/1 C 2wt 1,
Name and phone number of contact person
Tax Map No: Section rj 1 Block 3 Lot 3.j
Cross Street ai 2bow i)t U€
NOTE: LOCATION MAP MLST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
/6.°411/ 1/01
Signature of Applicant Date
Received by: e____Cr2: --------
:`y1 "S A 1,i QIP J.,7,-:«_cy .„ L .R.:"u.<I L7l. ze.'iz VICES
ON�ELL
S.C.T.M. NO. DISTRICT: 1000 SECTION: 51 BLOCK: 3 LQS):T 3."5 "' "' "
'L`''..:1`"� T �5' y q - -.IIZ rT. ZION
I li Srf:� � }.:iJi�r.�.e..��'�sl`Yr, _..1F • t- �.�«.�1'3��,FS�g'da�,. B�b�V FOR
DAIS
4Jsb`"f:::�.: IS`i ".r ..,..r NSy.,�El�i�.//�.."a��ONLY
Jb AIS„_.- , qS f'.iJ`2777,C---'. _Or�1"]- .
r
' APPROVED v
—ffir"..-----(4 )..'..----- 11,:,'dLx F` ria w- .i .m",C 3
TILIu a Er f-,..7.z1I0I,,1 DATE OF `OVAL
VACANT
DWELL
P Ato CI. 37.55
i AS (501
C 'Poo'
; TC 34.28
s•A°
oti out wile
0.3125
EL 38.5
16 326138 NIA EL 3123 HELLu RLs -7005' /
q i � y 2 3 a Ri.'PT
1 P ” 3 4 _ Y
O OYER 150° .k ' ( 4 's b a tit 3
-.r .Si M AV 5 ,' I�T F diYH E" _ MS�Z
DF
°OJ a.l.•w Hin.Y M-T�i a F} 4 3 ;;} ..4 e s _[' i. .�,,a
ti' °° rj E�r sr c IN FRONT
►"' oNEL. CO
J 1r / Iq OYER 150° ri
0
M- EL 39.6 N
i40a\
U) 16.0
I 61M311-5) N0 10.0N 14.0
CT
^q NICE 1 a2D)
cz os p 5S0 EL(41.5) 57'
l PROPOSA ' ow VACANT
Ilk pR►` , x5) b OCgt EL 40.3
d It 24.0
61
`� 54
W i3 EL42.0
W
.1 p \.
1 O,
. \
1 ✓ 8.3113 \ W
!{ Oj s
1 PROPOSED WELL CCI
• LOT 4
to
1 LOT 5 co)
j, tT tJ
Ul
.;: p.
1 .0 0
`%j VACANT O
1 ELEV. 41.0
TOP SOIL
-,i .2'
BROtYN EL 42.5
I :