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HomeMy WebLinkAboutRozakis, Tom (2) ti SOUTHOLD WASTEWA'1R DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 4277 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : MORRIS CESSPOOL Address 1: 2760 YENNECOTT DR City St Zip SOUTHOLD NY 11971 Descripton of Proposed Construction or Alteration ADDITION TO EXISTING SYSTEM APPROVED AS SUBMI'1.1'ED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. Name Of Owner TOM ROZAKIS Mailing Address 1 67-43 COOPER AVE City St Zip GLENDALE NY 11385 Property Address 1 585 DOGWOOD LN City St Zip SOUTHOLD NY 11971 Tax Map No. section 54.00 block 5 lot 56.001 Cross Street KENNY'S RD Building Permit Number Cross Reference: Issue Date: 11/18/14 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) IF ELIZABETH A. NEVILLE,MMC ti. 0 �4 Town Hall,53095 Main Road TOWN CLERK ' o P.O. Box 1179 C# 2 t Southold, New York 11971 REGISTRAR OF VITAL STATISTICS `+' 0�t 4 .�C Fax(631)765-6145 MARRIAGE OFFICER T* O'.0 Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER 0,1 illi *„.11 www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER • ,,,,,0,11 OFFICE OF THE TOWN CLERK __ TOWN OF SOUTHOLD T"0\' 12 2014 TO: Southold Town Building Department FROM: Sabrina Born, Southold Town Clerk's Office - DATED: October 29, 2014 Transmitted herewith is a copy of application No. 4277 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Morris Cesspool for Tom Rozakis 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 * * * * * * * * * * * * 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. . 71,,e /4 Signature ///2----/ - Dated I November 18, 2014 Morris Cesspool 2760 Yennecott Dr Southold,NY 11971 RE: 1000-54.-5-56.1 (Tom Rozakis) Dear Sir/Madam: Enclosed herewith is the Construction, Alteration or Modification Permit for a Septic Tank/Cesspool System for which you applied. AFTER the system is installed but prior to being used, an OPERATION PERMIT IS REQUIRED. The operation Permit is issued by the Southold Town Clerk's Office. The fee is Ten Dollars ($10.00) for a residential system and twenty-five dollars ($25.00) for a non- residential system. Your check should be made payable to the "Southold Town Clerk". An application form is enclosed. Please complete the requested information and return the application, proper fee, and LOCATION MAP (map must indicate the location of the cesspool(s)/septic tank(s), giving approximate distances in feet from any buildings to the pools and distances between the pools. Should you have any questions concerning this matter, please do not hesitate to contact this office. Very truly yours, Sabrina Born Clerk Typist Enclosures .$10©S�FFO�,�CoG ELIZABETH A.NEVILLE �'h`Z` .y`. Town Hall, 53095 Main Road TOWN CLERK % p P.O. Box 1179 REGISTRAR OF VITAL STATISTICS V3 Southold,� Southold, New York 11971 MARRIAGE OFFICER : G '� $ Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER yea��'�of Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER -,'� ��s'� 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 No. `-1 7 7 Permit No. Applicant Name vgRt s 33/er ee Applicant Mailing Address 2 760 y,‘,140&60 r7- ®L ij- Septic Tank-"or Cesspool Brief Description of Proposed Construction or Alteration fh, -1 /1d f7; c Location of Proposed Construction/Alteration: Owner of Property: / c)2..q,S Owner Mailing Address: CiLeALt cidefWY //3g5 Owner Property Address: 6-8-9 ZO611/0-00 5au±h d7 Name and phone number of contact person Tax Map No: s ,{� Section it/ Block X Lot . Cross Street 71 �'t7L ys / NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL 4774.6:, Signature of Applicant Date Received by: S i?„6:el.ad alfTAkA �b9 Q.2bdd' L ji