HomeMy WebLinkAboutPerivolaris, Michael SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 4068 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1: P 0 BOX 487
City St Zip LAUREL NY 11948
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 MICHAEL PERIVOLARIS
Mailing Address 1 P 0 BOX 800
City St Zip MATTITUCK NY 11952
Property Address 1 1155 LOVE LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 140.00 block 1 lot 20.000
Cross Street ROUTE 48
Building Permit Number Cross Reference:
Issue Date: 2/10/12 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
1111P-
i�
ELIZABETH A.NEVILLE,MMC �� �Gy Town Hall,53095 Main Road
TOWN CLERK , p P.O.Box 1179
t y 2 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS . p **��� Fax(631)765-6145
MARRIAGE OFFICER T' ��
RECORDS OF MANAGEMENT OFFICER _�(1,( `�� �� Telephone(631)765-1800
FREEDOM OF INFORMATION OFFICER # southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
- EUB
TO: Southold Town Building Department D CE
FROM: Linda J. Cooper, Southold Town Clerk's Office FEB - 7 2012
DATED: February 7,2012 BLDG.DEPT.
TOWN OF SOUTHOLD
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4062 for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Cesspool for Michael Perivolaris
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
Comments: �'
t. T
i i►-
- ..,
Ge_ i - ! ' /
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Signature
042--/9
Dated
►�,i'�g1F FOL,►
►►
►' Off' O
ELIZABETH A.NEVILLE,MMC � 4 Town Hall,53095 Main Road
TOWN CLERK p • P.O. Box 1179
t y Z Southold,New York 11971
REGISTRAR OF VITAL STATISTICS : W �►
O � ► Fax(631)765-6145
MARRIAGE OFFICER T' ��
RECORDS OF MANAGEMENT OFFICER 49/ `�� �► Telephone(631)765-1800
FREEDOM OF INFORMATION OFFICER ��►► southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 7, 2012
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4048' for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Cesspool for Michael Perivolaris
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
Comments:
Signature
Dated
/or * *(i
guidons A.NEVILLE ;' Town Hen,58095 Main Road
TOWN C \, P.O.Boa 1179
REGISTRAR OP'MAL STATISTICSSouthold,New York 11971
MARISA( OPF1C'SB R Fez(681)765-6145
B£CO S 0 ` _ ,,10 0 10 R T (681)165-1804
mum=OP 311PORMATIODT OFTICBR ; * . svot bo et
OFFICE OF THE TOWN CLERK{
• TOWN OF SOUTHOLD
SOulliOLD WASTEWATER DISTRICT
. APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 V or Non-Residential $25 APplication No. q o a
PetNo.
Applicant Name PECONIC CESSPOOL
Applicant Mailing.Address P- E?. BOx 4$7,
LAUREL, NEW YORK 11948
Septic Tee- ___or Cesspool_.:__
� •- �w V�` 1I(I�E •,►�♦y.-i l hz'. .Mi.i or i. :l�•
Al r ,1 A! C ecs/ .I
Location of Proposed.Construieti - : *cnC fi
Property:Ow=of l l 'e4ftVOt t 5
Owner Mailing Address: (;.1 )( 610 0
Owner Property Address: 1 1 5 L-i tIP . -oUile
f acck , y 1r '1 <
Name and phone number of contact person '0 930e
Tax Map No: Section 1 `l O Block l Lot. a 0
Cross Stmt
NOTE: LOCATION.MAP MUST BE s : I 'A i WITH A121, CATION. NEW
CONSI'RUCTION REQUIRES SURVEY 'Ai • :I !` TR DEPAR ,Y V
Ilk 0 / /
7 /4
Signa# of • .�•lt D e
Received by:
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