HomeMy WebLinkAboutCoutsouros, Anthony JUDITH T. TERRY .4. Town Hall, 53095 Main Road
TOWN CLERK P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS 080 �� Southold, New York 1197 l
MARRIAGE OFFICER ��, Fax (516) 765-1823
��� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 965 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ANTHONY COUTSOUROS
Address 1 : 20 CYNTHIA STREET
City St Zip HEMPSTEAD NY 11550
Descripton of Proposed Construction or Alteration
CESSPOOL SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES.
Name Of Owner COUTSOUROS, ANTHONY & HELEN
Mailing Address 1 20 CYNTHIA STREET
City St Zip HEMPSTEAD NY 11550
Property Address 1 1125 TUCKERS LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 59.00 block 10 lot 12.000
Cross Street GREENFIELDS LANE
Building Permit Number Cross Reference:
Issue Date: 3/04/93 Judith T. Terry
Southold Town Clerk
- (TOWN SFAI
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK O T ;• P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS jtrb Southold, New York 11971
�� Fax (516) 765-1823
MARRIAGE OFFICER ! O O��e
(� _' I '1D/ / Telephone (516) 765-1801
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i` MAR 3 1993 OFFICE OF THE TOWN CLERK
} ! TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 3, 1993
Transmitted herewith is a copy of application No. 994 for a Cesspool/
Septic Tank Construction Permit submitted by:
Anthony Coutsouros _ •
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.
ce
Linda J. Cooper
* * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE X
DISAPPROVE
Comments: /1veele,-/(
Signature
Date
3 9)
pFFItE OF THE TOWN THE TTown of Southold
Judith T. Terry, Application Town Clerk Application r ,rO� No. �J'� / .
Town Hall, 53095 \lain RoadVO Construction
P. O. Box 1179 , 4' `
�•� rs'; Alteration
p
Southold, New York 11971 � '0Nr L�
Telephone gel x14 1,?da-iv Residential
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(516) 765- 1801 " Non-Residential
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEIVATER DISPOSAL DISTRICT
•
APPLICATION
• for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Permit No. •
Fee •$
DATE
APPLICANT NAME: jtA, tf2044 / S° 412-
APPLICANT ADDRESS: 2 O ✓V 11/I„ S ,6 t4)1) ,-(2-0
SEPTIC CESSPOOL
DESCRIPTION OF PRO OSED CONSTRUCT ON OR ALTERATI N
UivG 1C // i
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ` le -1- , z - iu1 ' , 1/
• OWNER MAILING ADDRESS: ZU ,f f )I lrb
OWNER PROPERTY ADDRESS: //025 /mac-t �'-/zvt� djcvjc�
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TELEPHONE NUMBER OF CONTACT, PERSON: .S "' 53� 3 X13
TAX MAP NO. : Section S-9 Block 76 Lot /
CROSS STREET:r__� c Oec,t
, BUILDING PERMIT NUMBER CROSS REFERENCE:..
• 4000"/"-r------e›- .•
• ..mor gnature of Applicant
RECEIVED BY:
/ Town jerk's Office
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DATE: cJ
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