HomeMy WebLinkAboutVerveniotis, Eliseo ELIZABETH A.NEVILLE 11$ � Gyt: Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS %%%0 I,t! Southold, New York 11971
MARRIAGE OFFICER
Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER 4f� ���/1/ Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER = ' •*,�•1
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2143 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : BRUCE A. ANDERSON
Address 1 : SUFFOLK ENVIRON. CONSULTING
City St Zip BRIDGEHAMPTON NY 11932
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-99-0100
Name Of Owner VERVENIOTIS, ELISEO
Mailing Address 1 P.O. BOX 962
City St Zip SOUTHOLD NY 11971
Property Address 1 HORTON LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 54.00 block 3 lot 21 .002
Cross Street OLD NORTH ROAD
Building Permit Number Cross Reference:
Issue Date: 8/31/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
2/V3
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11�o,"SUFFO�,r
ELIZABETH A.NEVILLE � `Z' y Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �. Southold, New York 11971
MARRIAGE OFFICER �
O Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
. '�" � �11
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 27, 1999
Transmitted herewith is a copy of application No. 2229 for a Cesspool/
Septic Tank Construction Permit submitted by:
Bruce Anderson for Eleseos Verniotis .
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments:
igna
Dated / /
1
•
I
OFFICE OF THE TOWN CLERK
es „ ,,,,
��' AFF ouKc,I
TOWN,OF SOUTHOLD Os %*° �V Application No.� 7.
ELIZABETH A.NEVILLE,TOWN CLERK �+ 'Ij1 /
P.O.BOX 1179 Construction t/
SOUTHOLD,NEW YORK 11971 1
v ^�' Alteration
Vs
Tele hone y0,j' Qr�'�`, $10.00 - Residential
p •
(516) 765-1801 Ol + ,,'� $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
' i PE- qDATEl
APPLICANT NAME: u. csz% ,N...f
APPLICANT ADDRESS: ST-)F(= (r<- eA JL L Y . 1\js.x,r A)t)--( Kk__
°-• 1C�3 2.. 7t 0 lam(--L 1/� oir s 9IJ /'�`i
SEPTIC CESSPOOL 1 l tk.--3 ----
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION A-1)`J
pu3L. ? L..” (..) C.,-----
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: UgaeN / C' TI S
OWNER OF PROPERTY: __,.. h. is-0 Uj 2V I (yr-15
OWNER MAILING ADDRESS 1 • (3-74. R ..Z_-
_ ---(1-c (...v). i/L3 LI t 1 1 (
OWNER PROPERTY ADDRESS: i l Dru,--o -- . ( ,' -'g----
TELEPHONE NUMBER OF CONTACT PERSON: x.37 ,r/ 6 0
TAX MAP NO. : Section 5-1 Block Lot 2- ( i -1----
CROSS STREET: 0 (___D /N.3 0L1 -k Q20,--s--
BUILDING
IS--BUILDING PERMIT NUMBER CROSS REFERENCE:
4,7
Signa re f Applicant
RECEIVED BY: , ia.
4-1-' '
own Clerk's Office
DATE: ,q� 99
SURVEY OFPROPERTY .
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DEPARTMENT OF HEALTH SERVICES
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_ 13ti Qs 75. CERTFfO TO•
ELISEOS VER
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/ an familiar with the STANDARDS FOR APPROVAL ••"'
�A I AMD CONSTRUCTION OF SUBSURFACE SEWAGE -T LOW a
DISPOSAL SYSTEMS FOR SINGLE FAA&Y RESDEMCE3 '
i and will abide by the conditions set forth therein and on*NA ---'`
• permit /o construct.
bhy. e4Ye/•Pe WW1'''''••
CL-.50'
I1 4.•.o ti t The locations of wells and cesspools
i S 44'01 • w 44,i,{ shown horsan ore from field observations
® an and or from dale obtained from o 'NEW y
O '\t1.MEi Ole.
"> Vaca•,)f t'' o+." 40 .r
ways so. f. -;gi d N.Yi, . LIC. NO. 49618
NA
IQITA1 O1U ASSUMED DATUMANY ALTERATION OR ADDIRGN TO THIS SURVEY IS A VIOLATION '1 1 O' '
*WOW a _ lit'won auaa i .al ■•>iaontuaent OF SECTION 7209 OF RIE YORK STATE EDUCATION LAW. (516 • 96. ''4r 0
111 rt1MY rat CHUM a EXCEPT AS PER SECTION SUBDIVISION 2. ALL CERTIFICATIONS A. •
!'OTR Atva1s a HEREON ARE VALID FOR MAA AND COPIES THEREOF ONLY IF P. O. O ' rt-t1�S f
I I�{p�M AREA 3.0250 ac
agars Olin All MIX pp IAM SAID MAP OR COPIES BE *It IMPRESSED SEAL OF THE SURVEYOR 1230 TR• • - -EET n_ e�
WHOSE SIGNATURE APPEAR•+HEREf14. 0' SOUTHOLD, N.Y. 11971 e7 113