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Town Hall, 53095 Main Road
c� O 1� P.O. Box 1179
40'
‘4,0 Southold, New York 11971
JUDITH T.TERRY ,® „ �� r FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 438 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : KATSIMATIOES, ANTONIOS
Address 1 : KATSIMATIOES, CALLIOPE
City St Zip JACKSON HEIGHTS NY 11370
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED ON SKETCH AND AS APPROVED BY THE SUFFOLK COUNTY
DEPARTMENT OF HEALTH SERVICES.
Name Of Owner KATSIMATIOES, ANTONIOS
Mailing Address 1 KATSIMATIOES, CALLIOPE
49-18 21ST AVENUE
City St Zip JACKSON HEIGHTS NY 11370
Property Address 1 MAPLE LANE
City St Zip GREENPORT NY 11944
Tax Map No. section 35.00 block 8 lot 1 .000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 12/13/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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F TOWN OF SOUTHOLD �5�, •,Y tom,: %N 0 P.O. Box 1 179
-m, ..., . ....,.., �—_4101 •��O. Southold, New York 11971
JUDITH T.TERRY .,...� tidy TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: December 9, 1988
Transmitted herewith is a copy of application No. 445 for a Cesspool/
Septic Tank Construction Permit submitted by:
Antonios and Calliope Kats imatides •
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.
o
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE •
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Comments: cs„ .a..,.r�-�..ca A. aN'L c e L �k F" G
`ili f .°-,a % .Q Q. a .p( , 101 �8, -
)1:c.)(LA0„. c..e, .4 Ge-
Signature
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Dated
' • t
OFFICE OF THE TOWN CLERK Oc0F11yu D
Town of Southold
Judith T. Terry, Town Clerk Application No. 1/6-
Town Hall, 53095 Main Road Construction
P. 0. Box 1179 ra
Alteration
Southold, New York 11971 .L-
TelephoneOl [ NJA\70
o �� Residential
•
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ J O
DATE /'431(8rS7
APPLICANT NAME: 000. 5 67-149-e- Xliesx 7-7 r,s-
APPLICANT ADDRESS: 41' (f c9-("Ye_
,/,390-/z rod ®3 G y (/37V
SEPTIC V CESSPOOL L-"
DESCRIPTION F PROPOSED CONSTRUCTION OR ALTERATION
/&
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CO STRUCTION OR ALTERATION:
OWNER OF PROPERTY: -Ah-asPc'e,f 7 C/1 Ti/ Jii/C1 es
OWNER MAILING ADDRESS: 49-n c2/ €-
f� E6VI o' Aq 1/3`7°
OWNER PROPERTY ADDRESS: J JOf
TELEPHONE NUMBER OF CONTACT PERSO :7/2)
TAX MAP NO. : Section 0.3 S Block R- Lot / •
- CROSS ST R EET: ,41/% EjC2/9, 7, /e2ai€
BUILDING PERMIT NUMBER CROSS REFERENCE:_
4., (
Signature of Applicant
RECEIVED BY:
Town CI rk's Offi e
DATE: /(919/4
i
•
^ SUFFOLK CO.HEALTH DEP .APPR�QVAL, ' 'r' r .�/.1),
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.�t r JQ t (tJ '.' p/, S>> �\1 "V-1-`v STATEMENT OF INTENT 1
_ IVe-A� - '' /%r��y �J"��I�p THE WATER SUPPLY AND SEWAGE DISPOSAL
����N � x lS ,..( ��' SYSTEMS FOR THIS RESIDENCE r WIL247 L'i
i'" TOWnr F-', '` �g �` CONFORM TO THE STANDARDS OF` THE
O ."�OLITHOLO; I�_ ill -Ma,t� r�� , - e SUFFOLK CO, DEPT_ OF HEALTH SER -,_
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_qpn`@� pB[,pp�Aa_ a , .uJ • APPLICANT
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AAT1 INSPECTION ,ti • SUFFOLK -COUNTY -DEPT: OF HEAL TA
} — `a' r SERV ICES — FOR' APPRQ AC:+t�`�,OF ';
1 / • \\ \> a "� CONSTRUCTION ONLY
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