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ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax(516)765-6145
Telephone (516) 765-1800
Permit No. 2102 R Residential X Non -Residential
Fee $ 10.00 Septic X Cesspool
9W&'FAM11:1111=101
Name : JEFFREY E SUSAN KAYTIS
Address 1: 88 SANDY COURT
City St Zip RIVERHEAD NY 11901
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 #1110-99-0117
Name Of Owner KAYTIS, JEFFREY & SUSAN
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Mailing Address 1 88 SANDY COURT
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City St Zip RIVERHEAD NY 11901
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Property Address 1 2600 PARADISE POINT ROAD
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City St Zip SOUTHOLD NY 11971
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Tax Map No. section 81.00 block 3 lot 15.004
------ --- ------
Cross Street ROBINSON ROAD
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Building Permit Number Cross Reference:
Issue Date: 7/06/99
----------------------------------
Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ELIZAB
TO LERK o -
y 2
REGISTRAR VIT A T %lb-,y • ��
MARRIkG
RECORDS MANAGEMENT OFFICER �f01 �a0
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 22, 1999
Transmitted herewith is a copy of application No. 2190
Septic Tank Construction Permit submitted by:
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (516) 765-6145
Telephone (516) 765-1800
for a Cesspool/
Jeffrey and Susan Kay -tis
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:
-Isfgnaturk�
Dated
I
1
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
ELIZABETH A. NEVILLE, TOWN CLERK
P.O. BOX 1179
SOUTHOLD, NEW YORK 11971
Telephone
(516) 765-1801
Permit No.
Fee $
TOWN OF SOUTHOLD
Application No. n
Construction
Alteration
$10.00 -Residential
$25.00 -Non-Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICANT NAME:
APPLICANT ADDRE
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
DATE �',)�(q 9
JUN 2 2 1999
[own Clerk soulpold
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTR C ION OR ALTERATION
�i,00., �-r)-
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCION OR ALTERATION:
OWNER OF ;��l
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:26C)o
O-Q_x
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO.: Section S' Block Lot
CROSS STREET : �c> 1� �'►So��l '
BUILDING PERMIT NUMBER CROSS REFERENCE:
RECEIVED BY:
owO Clerk's
DATE:
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pucant
It 901
5URYEY OF PRi
51TUATE: BAY1/IEW
TOWN OF 5OUTHOLD
SUFFOLK COUNTY, NY
SURVEYED 12-14-98
AMENDED 05-20-99
SUFFOLK COUNTY TAX u
1000-81-3-15.4
CERTIFIED TO:
JEFFREY F. KAYTI5
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■ MONUMENT FOUND
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-- E AREA = 2.36 ACRE -5
Y.S. LIC. N0. 50202
6 EAST MAIN STREET
RI VERHEAO,N.Y. 11901
369-8288 Fax 369-8287
REFERENCE N 96-253E