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ELIZABETH A.NEVELLE �`Z` y y Town Hall, 53095 Main Road
TOWN CLERK i P.O. Box 1179
k Cr) Z Southold,New York 11971
REGISTRAR OF VITAL STATISTICS V'
� O � # Fax (516) 765-1823
MARRIAGE OFFICER � y �1 Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER .00
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2197 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : EAST ISLE CUSTOM BUILDERS
Address 1 : 1706 NORTH HIGHWAY
City St Zip SOUTHAMPTON NY 11968
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 #R10-99-0129
Name Of Owner PAVLIDES, DIMITRIOUS & KATHY
Mailing Address 1 6807 RIDGE BLVD.
City St Zip BROOKLYN NY 11220
Property Address 1 790 HICKORY ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 54.00 block 6 lot 6.000
Cross Street SOUNDVIEW AVENUE
Building Permit Number Cross Reference:
Issue Date: 12/21/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
w ,/���ilii 117
` ` 1'I,,,O�O0.u,-,e
ELIZABETH A.NEVILLE l'Z` y Town Hall, 53095 Main Road
TOWN CLERK t, o P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .s. �1 Southold, New York 11971
MARRIAGE OFFICER V O 4 Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER '1/4 O sr 0 Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER — .4 * II.
,11
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 29, 1999
Transmitted herewith is a copy of application No. 2285 for a Cesspool/
Septic Tank Construction Permit submitted by:
East Isle Custom Builders Inc. for Dimitrious & Katherine Pavlides .
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:co
APPROVE +/
DISAPPROVE
Comments:
ignature
,/ ) tea Hi
Dated
1 OF'F10E OF THE TOWN CLERK "' �`{Ot�j 4
TOWN OF SOUTHOLD ` �1 CSG= Application No.ga K5
FLr7ABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 Construction v�
SOUTHOLD,NEW YORK 11971
Alteration
Telephone -- et*
�� $10.00 - Residential
(516) 765-1801 �.� 1
0', $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICuw..
NOV 2 9 1999
APPLICATION
Iowa l swum
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE // Z 0,
APPLICANT NAME: East Isle Custom Builders, Inc.
APPLICANT ADDRESS: 1706 North Hwy, Southampton, Ny 19968
SEPTIC x CESSPOOL x
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION N/D
1000 gallon septic tank and 300 square foot of sidewall
leaching poll
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Dimitrious & Katherine Pavlides
OWNER MAILING ADDRESS: 6807 Ridge Blvd. Brooklyn, NY 11220
OWNER PROPERTY ADDRESS: ' I O 4
TELEPHONE NUMBER OF CONTACT PERSON: 516-287-0772
TAX MAP NO. : Section 54 Block 06 Lot 06
CROSS STREET: Sound View Ave.
BUILDING PERMIT NUMBER CROSS R ERENCE:
Sig at , of Applicant
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RECEIVED BY: -fir
own Clerk's Office
DATE: \\` /l cj`\
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D 0 I ;,,is) SCALE 1" = 30' JUNE 17, 1999
< __ S.C.TM. DIST 1000 SEC. 54 BLK. 06 LOT 06
133.45' - II Aa roD N
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DWELLING - 94�,/t _.'�,P y+wRy
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7/0007 IJ.5 07100ED ACROSS STREET-ELLS IN,FRC',0005.SAWAor rN,EAR YARDS (516) 'a 8-5330
St
SEPTK WANK ecppLW/POOL 70 E Chase.ammers�L"£
GROUND AA1ER 0 e_AR Pool T.Combo.L. Robert A Kock L.S.
Cool Ground Surveyors,P.C.
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