HomeMy WebLinkAboutPetikas, Theodore .-
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ELIZABETH A. NEVILLE ��`Z`0 Ot; Town Hall, 53095 Main Road
TOWN CLERK ti P.O. Box 1179
% x Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 171 t
MARRIAGE OFFICER k
1 Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER :** a0�' � Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER i�'�IJ• '���d
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2113 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : THEODORE PETIKAS
Address 1 : 225 STEWART AVENUE
City St Zip BETHPAGE NY 11714
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 #R10-99-0104
Name Of Owner PETIKAS, THEODORE
Mailing Address 1 225 STEWART AVENUE
City St Zip BETHPAGE NY 11714
Property Address 1 SOUND ROAD
City St Zip GREENPORT NY 11944
Tax Map No. section 35.00 block 1 lot 8.000
Cross Street NORTH ROAD
Building Permit Number Cross Reference:
Issue Date: 7/09/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE y0 ( . FZ Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
CA z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax Fax (516) 765-1823
MARRIAGE OFFICER 4' ! Tele hone (516) 765-1800
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RECORDS MANAGEMENT OFFICER P
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: July 7, 1999
Transmitted herewith is a copy of application No. 2201 for a Cesspool/
Septic Tank Construction Permit submitted by:
Theodore Petikas
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. Coope
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE ✓
DISAPPROVE
Comments:
Signature
Dated
,
OFFICE OF THE TOWN CLERK ,�'�S�`f Utir ". /
TOWN OF SOUTHOLD � COZ. &4. Application No. ;2_9.-0
ELIZABETH A.NEVILLE,TOWN CLERK ,
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971
Alteration
Telephone Oe, Ari $10.00 Residential . ,
(516) 765-1801 -----4T62 $,�,''.
.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE itAil
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APPLICANT NAME: 1-Ff-tot o f_4„ E -rt -
APPLICANT ADDRESS: _�S.-- <, t Qtjj1.._....,
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SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION A,ee.,.)
D'YLik_. ......71t....4.-1".../..2j froz, f e_.,„,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: <-714.Z0 1::>o VZ E ) I<F
OWNER MAILING ADDRESS: 2r- ,I at.}.64
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OWNER PROPERTY ADDRESS: _....i ,,;;,f�.„mo- rdr '��i► rjfirff%r.
jleYvvi I Add 1 ..wisa A ° \` '
TELEPHONE NUMBER OF CONTACT PERSON: / V— ,qQ9/ �,4 (2o 6'
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TAX MAP NO. ' Se
" ction ‘'� C Block Q I Lot C 'l'
CROSS STREET: of exiyid ?a 74 (A 'A ? /1-1.1
BUILDING PERMIT NUMBER CROSS REFERENCE:
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410►1. ., A, n / .-4 ?11
Signature "of Applicant
RECEIVED BY: L 2- SV
' / lGTown Clerk's Office
DATE: 1/ l 9
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APPROVED
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EXPIRELLFRaTE Or AEPROVAL
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