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JUDITH T. TERRY ►+ Town Hall, 53095 Main Road
TOWN CLERK �O T • P.O. Box 1179
REGISTRAR OF VITAL STATISTICSU1 �� Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
� ® � •
,y®1 ®��� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 967 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JOAN TYRER
Address 1 : LEWIS REALY GROUP
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 1/12/93.
Name Of Owner SERGLIO, AGATHOCLIS
Mailing Address 1 30-51 CRESCENT STREET
City St Zip ASTORIA NY 0000
Property Address 1 STROHSON ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 103.00 block 10 lot 7.000
Cross Street BALDWIN PLACE
Building Permit Number Cross Reference:
Issue Date: 4/02/93 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY Town Hall, 53095 Main Road
• TOWN CLERK i ® r P.O_ Box 1179
sr �• Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 1 . ,
E �_f-G 603rE i / j V r 1 Fax (516) 765-1823
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6;7 L9 �� ,, , ,s .,,, ;4# ,r•„, i0 Telephone (516) 765-1801
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A{ 7 MAR 3 Sq, i lG
@i 1 bA OFFICE OF THE TOWN CLERK ___
rr.f ' (i '€. TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town- Clerk's Office
DATED: March 3, 1993
Transmitted herewith is a copy of application No. 993 for a Cesspool/
Septic Tank Construction Permit submitted by:
Joan Tyrer for Aqathoclis .
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 1K
DISAPPROVE
Comments: - .S .c... e4, o-,^ O oZi.4 .. o ust, ZATI 02.4, CV„vaid.
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Signature
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Dated
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OFFICE OF THE TOWN CLERK � 3trO
Town of Southold „0 ,
Judith T. Terry, Town Clerk j i!' �; �vOy Application No. l��
Town Hall, 53095 Main Road c """ �' _
P. O. Box 1179 v' i1�° "n Construction v
Southold, New York 11971 P�� i .2-� v Alteration
�r��� �o��� "
Telephone 1 r t Residential
(516) 765- 1301 -nv
Non-Residential
• TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
• for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 999
Fee .$ /0
DATE 11-) 3
APPLICANT NAME: J , S �� P C
APPLICANT ADDRESS:./%4,) (2 e e
A Ci r T v a 9
12 // 9 5
SEPTIC CESSPOOL -
DE CRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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11
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: '!
• OWNER MAILING ADDRESS: 'j& -- �� a , , p
. 74 s .41 / /---�
OWNER PROPERTY ADDRESS: ST J 0
e. .
C-(
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /0,3 Block
/b Lot
. • CROSS STREET: 61..-ecl Cc)L.. 111° I L-�L,
BUILDING PERMIT NUMBER CROSS REFERENCE:..
-7-- Signature of Applicent
RECEIVED BY: 4446,CA--7,62
Town Clerk's Office
DATE: Y. I/P-- .
,i l' SUFFOLK CO HEALTH DEPT APPRO1LAL" 'L
' a PLgAbETE
T
-� It is the apo!icant's responsibflity 1�0
maintain adeq+sate sanitary distance r;
i 1 and sewage, ,�
between ail water s�pp Y
HAUSER.•
� I -� d+s�ssal faci►izses-
VAC.fi,Pl ') I P ^ SyATEM6N�UF.tN-FQWI ��
U THE WATER SUPPLY AND SEWAGE DISPOSAL
O SYSTEMS FOR THIS RESIDENCE WILL
_ }( +\� l CONFORM TO E STANDARDS OF THE
17: +J 'E FIOIk a• J84 �4'<=S)M 2 J�f fi Q II
ie6 SUFFOLK CO EPT OF HEALTH SERVICES.
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1 I 7 APPLICANT r.
/(' i; / 32' PROP WELL_• > L, 7 I CONC GOVEt�
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} / I- - I,: 10 ,li 0 SUFFOLK COUNTY DEPT OF HEALTH
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rJ ,, 1 t 6o' ., ,� ty +� SERVICES - FOR APPROVAL OF
Lt 1 ;` tl� - r •i- GAR — P/ : 0 I - CONSTR�„C,JION ONLY
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J, +i t, PROP. I ?/LFN > `'�t �� U ` H.S REF NO. - A
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0 i) ,v 1:-- I SUFFOLK CO TAX MAP DESIGNATION-
(_�I sb ul± 7D /" 0 I DIST SECT BLOCK PCL.
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--z � _ --- - -- -- -- '? 07 71 I N 1 (JJJ f05 IO 7
-� 54 -G w ,� // 240.0 \ OWNERS ADDRESS
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•.. \ I P.O E 702
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