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Home My WebLink AboutAgarabi, Cyrus SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 4075 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : CYRUS AGARABI Address 1: P O BOX 450 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 INSPECTION REQUIRED. Name Of Owner GYRUS AGARABI ------------------------------ Mailing Address 1 P O BOX 450 ------------------------------ ------------------------------ City St Zip MATTITUCK NY 11952 -------------------- -- ---------- Property Address 1 265 WESTVIEW DRIVE ------------------------------ ------------------------------ City St Zip MATTITUCK NY 11952 -------------------- -- ---------- Tax Map No. section 139.00 block 1 lot 25.000 Cross Street BROWN ROAD ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 4/05/12 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) �► � �Og�FFO(,�-c ELIZABETH A.NEVILLE,MMC �y� �Gy Town Hall,53095 Main Road TOWN CLERK p P.O.Box 1179 C4 2 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS i +� Fax(631)765-6145 MARRIAGE OFFICER O! �aO� Telephone(631) 765-1800 RECORDS OF MANAGEMENT OFFICER southolone(6 1) 76 -1800t FREEDOM OF INFORMATION OFFICER FCE �wF OFFICE OF THE TOWN CLE TOWN OF SOUTHOLD MAR 2 6 2012 TO: Southold Town Building Department BIDc. DEPT. _ TO!NN or"OUTHoI) FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: March 23, 2012 Transmitted herewith is a copy of application No. 4075 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Cyrus Agarabi (work by Coastline Cesspool) 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. * * * * * * * * * * * * 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 /Z Dated ELI7ABETH A.NEVILLE =`1` �G.y Town Hall, 53095 Main Road TOWN CLERK p P.O. Box 1179 ti Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICS ItO N� MARRIAGE OFFICER y �•1C Fax(631) 765-6145 RECORDS MANAGEMENT OFFICERTeleA hone (631) 765-1800 FREEDOM OF INFORMATION OFFICER O'� �a 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 J or Non-Residential @ $25 Application No. `-IC-)75� Permit No. ApplicantName Applicant Mailing Address 01V®. m/,-Ti Tu % & Septic Tank or Cesspool Brief Description of Proposed Construction or Alteration /N-S>A1- S L'C-0"140 6�Spot)L' Location of Proposed Construction/Alteration: Owner of Property: a yiW S 1"6*C� Owner Mailing Address: T• 0• 6')x V 5 y M'}-r"7'i 7-u Al! Owner Property Address: S W ��% Ur�-n1 �i V r� 7-j', u � ti. Name and phone number of contact person C".v�S7t,NS✓� - 73 �/ �y� Tax Map No: Section A"t9 Block / 3 1. Lot D/—Z Cross Street 0�0�&'Z-s i_z 4-rj NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL Signature of licant Date Received by: -� BROWER R . ,s O,4 D 0 . - •moo, - N M fc' N/0/F BA R EARA REITE R SURVEY OF ° 1L PROPERTY ATMATTITUCK TOWN OF SOUT HOL D i °�`�• // o.� `^rte` qY u ' �. j� �$� �� A, SUFFOL K CDU NT Y, N.Y. Z,6p 3 \ /, ,� gR.. 1000 - 13 9 �f 01 - 25 6p� 6 • � �� Scale 1 40 July 29, 1987 V � i *' ass fS�r�bS i f vV \air =P S{i kh! o j ti •p R Try, , • 2��s► s �y4 `•, QP CERTIFIED T0: GERALD P. McGINT Y ry"� - N/0/F � TICOR TITLE GUARANTEE a %Q (O ALI ALARA BI JUNE M. McGINTY oo \ o o- G c9 R� �p �b LAND S� C:) to �} Prepared in accordance with the'minimum N t� � �\ standards for title surveys as established by Q�O. 4968 the L.I.A.L.S. and approved and adopted Q%NE- for such use b The New York State Land / y �1 :e TT:4, , N.Y.S. L IC. NO . 3• n� .-{int^ � � I •P � SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4437-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner CYRUS AGARABI ------------------------------ Mailing Address 1 P O BOX 450 n Mailing Address 2 ----------------------------- I City St Zip MATTITUCK NY 11952-0000 �6�2 Property Address 1 265 WESTVIEW DRIVE ------------------------------ Property Address 2 ------------------------------ City St Zip MATTITUCK NY 11952-0000 -------------------- -- ---------- Owner Telephone No. 000-000-0000 ------------ Tax Map No. section 139.00 block 1 lot 25.000 Cross Street BROWARD ROAD ------------------------------ ---------------------------------- Issue Date: 4/17/12Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) I �OguFFot�c � ®G ELIZABETH A.NEVILLE �� y< Town Hall, 53095 Main Road TOWN CLERK c�i� g P.O. Box 1179 REGISTRAR.OF VITAL STATISTICS O Southold, New York 11971 MARRIAGE OFFICER 'j4 �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER 1 `� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 or Non-Residential @$25 Application No. 3 Permit No. Owner Name Owner Mailing Address Owner Property Address �! "tl Owner Telephone No. Tax Map No: Section Block 3 5 Lot Cross Street 6Eao_Af-o Please check each that applies: New Construction / Alteration to ExI Ing System Residential Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SCHD approval.) 113 Signature of Appli ant Date Received by: . - - : .�- ' �� 5 � � � � -- �.3� •-\ �,l - - :�