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Home My WebLink AboutKoutsoubis, Alexe ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 2034 R Residential X Non -Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : ALEX KOUTSOUBIS Address 1: 38-70 DOUGLASTON PKY City St Zip DOUGLASTON NY 11363 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 #1110-99-0034 Name Of Owner KOUTSOUBIS, ALEX ------------------------------ Mailing Address 1 38-70 DOUGLASTON PKY ------------------------------ ------------------------------ City St Zip DOUGLASTON NY 11363 -------------------- -- ---------- Property Address 1 THE STRAND ------------------------------ ----- ------------------------ City St Zip EAST MARION NY 11939 -------------------- ------------ Tax Map No. section 30.00 block 2 lot 64.000 Cross Street THE LONG WAY ------------------------------ Building Permit Number Cross Reference: Issue Date: 3/10/99 ---------------------------------- Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) 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 TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: March 9, 1999 a031� Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 Transmitted herewith is a copy of application No. 2114 for a Cesspool/ Septic Tank Construction Permit submitted by: Alex Koutsoubis 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: ignat Dated 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 $ o��FFo�K�oG tt� W TOWN OF SOUTHOLD Application No;?-,-` / Construction L, ---- Alteration $10.00 -Residential $25.00 -Non-Residential SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL DATE - '? ' 9 1 APPLICANT NAME: Aly X APPLICANT ADDRESS: 3X - SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CQNSTRUCTION OR ALTERATION , LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: AAE K OWNER MAILING ADDRESS: 0 v �- OWNER PROPERTY ADDRESS: 1itSL- 1Sh&1y 1 d TELEPHONE NUMBER OF CONTACT PERSON: TAX MAP NO.: Section / 030 Block CROSS STREET: -G� Lon: BUILDING PERMIT NUMBER CROSS REFERENCE: Lot (0 q, Signature of pplicant RECEIVED BY: n Clerk's Office DATE: 'Z. • _d7l*oN 030 ,BLOCS 02 /-or a4- CF HEALTH SIMR14WES J 114T jjv 60 7RUC77"XFOR A LofJ6 ONLY 1�4 0 -q rL .701uw -uw_.." gtEQ pat /is /I " - 1'0'r .69 . 16A0 !eAP 24 folo .4 d6 yod /to lj ,,ple e(6 e 09g 0 .. . .... ......... ....... EQUmED EXCAVATION INSPEGMN�71111 'T E) y - FOR SANITARY,,, ST BY '\ -h \ ; \ %n t\ lk 4 r - M leAel fe'; 4 0000 4 .00.01 fo MAP OF PROPERTY SrrUA*M AT . �`Q.S"�'��IAiPION TOWN Or SOWAW040 Su.r.c06X_ -00Z1.dV7Y,, N- Y - Awl sell PLEASE r\10TE Placed 1-1 area. ROBERT A. HAYNES PROFESSIONAL LAND & CITY SURVEYOR 741 B WEST JERICHO TURNPIKE HUNTINGTON, N.Y. 11743 219 SYOSSET-WOODBURY ROAD SYOSSET, N.Y. 11791 UNAUTHORIZED ALTERATION 01 ADDITION TO THIS SURVEY IS A VIOLATION OF 716-631-7596 516-496-4530 SURVEYED SECTION 770! OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING AlAe4lV 5 /99.8 - - OF WALTER I. BROWNEl GUSTAVE "t-Al.06".P TIME LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SMALL NOT 81 CONSIDEREDP"Owcfion TO 16 A VALID TRUE COPY. ECIVfrl'i GUARANTEES OR CERTIFICATIONS INDICATED HEREON SHALL RUM ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS 804W TO THE TITLE COMPANY ik GOVERNMENTAL A01INCY'AND LL40IN INSTITUTION LIVD HEREON, AND TO THE LOT NUMBERS TO MAP 0,- ';0Ar0JZc &ddFr4-c*we,-'q ASSIGNM OF I LENDING INSTITUTION. a 0-f4drA0 0,v 1t1,vAr ,Vp IS 7S Af OUARANITM Olt CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. swy�Oi= 42