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JUDITH T. TERRY ; iC Town Hall, 53095 Main Road
TOWN CLERK v 2G ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS • Southold, New York 11971
MARRIAGE OFFICER Va` '��` Fax (516) 765-1823
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OFFICE
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 786 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : EMMANUEL & BARBARA CARAVANOS
Address 1 : 38-28 217TH STREET
City St Zip BAYSIDE NY 11361
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 11/21/91 .
Name Of Owner CARAVANOS, EMMANUEL & BARBARA
Mailing Address 1 38-28 217TH STREET
City St Zip BAYSIDE NY 11361
Property Address 1 STARS ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 22.00 block 2 lot 24.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 12/17/91 Judith T. Terry
Southold Town Clerk
I TOWN SEALL_
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JUDITH T. TERRY � L Town Hall, 53095 Main Road
TOWN CLERK ` T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER VO �. � Fax (516) 765-1823
It
I�� Telephone (516) 765-1801
411
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD } f�
To: Southold Town Code Enforcement Officer , DEC _ 21991
From: Linda Cooper, Southold Town Clerk's Office
Dated: December 2, 1991
Transmitted herewith is a copy of application No. 804 for a Cesspool/
Septic Tank Construction Permit submitted by:
Emmanuel and Barbara Caravanos .
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE �C
DISAPPROVE •
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Dated UEC 111'401
Town Ghik Southold
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OFFICE OF THE TOWN CLERK Oc0Fat,? ,
Towp of Southold T `•
Application No. TO
Judith T. Terry, Town Clerk i " • "c„ ..�
Town Hall, 53095 Main Road ' Construction
40. 0. Box 1179
Southold, York 11971 �• L Alteration
New .may O� /
Telephone ,�1 r i 1% Residential V
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE J, en16er
APPLICANT NAME: EMMANUEL AND BARBARA CARAVANOS
APPLICANT ADDRESS: 38-28 217TH STREET , BAYS IDE, NEW YORK 11361
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
sA91G imf' x
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: EMMANUEL AND BARBARA CARAVANOS
OWNER MAILING ADDRESS: 38- 28 217TH STREET
BAYSIDE, NEW YORK 11361
OWNER PROPERTY ADDRESS: iirttR5 xO4J E, c/ 844)/0n/
/ 9 37
TELEPHONE NUMBER OF CONTACT PERSON: (718) #224-7525
TAX MAP NO. : Section 22 Block 2 Lot 24
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:..
tt #tfIi
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: / qZ_IT/
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7Ci l , ,•. • • STAIRS Aa• , rr F • " SUFFOL$CQ.HH.S. 9:iii-,Gj
m m I MAP 0d2Q T1r
'C.-. 3u VEY � STATEMENT OF INTENT '
,+ i a / p �/� �/►� /�/�/ THE WATER SUPPLY AND SEWAGE DISPOSAL
,• EI r 1M NUEL f E3ApiE3 -•/12A C412AV•A C)S SYSTEMS FOR THIS RESIDOICE WILL
: CONFORM TO TME STANDARDS OF THE
.,}, ` SUFFOL CO.' rT OF I�fALTH SERVICES.
lt. f c VA$cxJla?Z O' ;awa TOwn1 OF 5 -JTJlOLO,NY. APPL CANT
Y
, asssYoo SUFFOLK COUNTY DEPT. OF HEALTH
, •� ;:i 'y. 'N SERVICES - FOR APPROVAL OF
‘,6 i",`,' �.. CONSTRUCTION ONLY
i' isokaiie area
(!rows} / DATE: 11-Z l-9 '
? \ M.S.REF.NO.: ,,�I .
s� WELL COVENANT REQUIRED APPRovED: L� ,
woo.
PRIOR TO
I FINAL APPROVAL
SUFFOLK CO.TAX MAP DESIGNATION:
N.78'96'30-E. - 120.0•
IDIOOQ d22 BLOCK P L.
i 11/11 OWNERS ADDRESS:
i kW/. wRll Scotto t 40'411' :38.-5:12:147.4:-.,54',//50.i
r` .' `. Anva41 2Q,400
r! t _ 1`O "-- '.T ®0rnoncti*+ Tel.212 224-7625
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