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Home My WebLink AboutAndriotis, Nick 4 T SOUTHOLD WASTEWA'hR DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 4274 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : GARY TABOR Address 1: 680 NAVY ST City St Zip ORIENT NY 11957 Descripton of Proposed Construction or Alteration ADDITION TO EXISTING SYSTEM APPROVED AS SUBMI'rrJu. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. Name Of Owner NICK ANDRIOTIS Mailing Address 1 21120 SOUNDVIEW AVE City St Zip SOUTHOLD NY 11971 Property Address 1 21120 SOUNDVIEW AVE City St Zip SOUTHOLD NY 11971 Tax Map No. section 51.00 block 3 lot 14.000 Cross Street CLARK RD Building Permit Number Cross Reference: Issue Date: 11/18/14 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) t j FFO fr' ELIZABETH A. NEVILLE,MMC ��*,1��"O C goy Town Hall,53095 Main Road TOWN CLERK C P.O. Box 1179 y 2 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p �� Fax(631)765-6145 MARRIAGE OFFICER y. / Telephone(631)765-1800 ( 4 RECORDS MANAGEMENT OFFICER �. `0„.e. www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD r - L 4 TO: Southold Town Building Department ,_ FROM: Sabrina Born, Southold Town Clerk's Office DATED: October 27, 2014 Transmitted herewith is a copy of application No. 4274 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Gary Tabor 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. Signature ature /7/5 ..0 ' Dated 1 November 18, 2014 Gary Tabor 680 Navy St. Orient,NY 11957 RE: 1000-51.-3-14 (Nick Andriotis) 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 ,/�,�o� SUFFO(, o ELIZABETH A.NEVILLE 1`t` G.y Town Hall, 53095 Main Road TOWN CLERK p P.O. Box 1179 REGISTRAR OF VITAL STATISTICS W Southold, New York 11971 O46MARRIAGE OFFICER : '� � Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER W a0*.1 Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER = '� * 01 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 l- 'or Non-Residential @$25 Application No. 110 7L-1 Permit No. Applicant Name l9 l' y ) J2 H O )' Applicant Mailing Address S& 14/14 S j e9t it Septic Tank or Cesspool V Brief Description of Proposed Construction or Alteration X 10 1--(4-CA/ h/?. ff(90 Location of Proposed Construction/Alteration: Owner of Property: /, `C 1 . ,y,/d T )' O �, S Owner Mailing Address: Owner Property Address: 2 5 o u Name and phone number of contact person 3 2 i' / 7 Tax Map No: l Se / S i- Block 3 , Lot ' _ / Cross Street N / P- K NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL )02 71)4)- Signature 1 4). Signature of Mplicant Date Received by: t - k CC;V rIr7-\7 j5z • 14- v 0 Vtic e • N( 6`"