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JUDITH T.TERRY sfgTown Hall,53095 Main Road
TOWN CLERK cry P.O.Box 1179
$ Southold,New York 11971
REGISTRAR OF VITAL STATISTICS \ ®�
MARRIAGE OFFICER �1 Fax(516)765-1823
,s��, �®
RECORDS MANAGEMENT OFFICER ®4 `z r' f°.06�
Fax
(516)765-1800
FREEDOM OF INFORMATION OFFICER �•�„ �•��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1264 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MATT MARKOWITZ
Address 1 : 319 WEST 48TH STREET
City St Zip NEW YORK NY 10036
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-94-0004
Name Of Owner MICHELAKIS, GREGORY
Mailing Address 1 65-27 171ST STREET
City St Zip FRESH MEADOWS NY 11365
Property Address 1 15985 MAIN ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 23.00 block 1 lot 11 .002
Cross Street
Building Permit Number Cross Reference:
Issue Date: 12/16/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
®��FFOLKc®G [[[
JUDITH T. TERRY • Town Hall, 53095 Main Road
TOWN CLERK : v r= : P.O. Box 1179
U �: �� Southold, New York 11971
REGISTRAR OF VITAL STATISTICSo$ Fax (516) 765-1823
MARRIAGE OFFICER =_ /� ® �� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER QI ill
FREEDOM OF INFORMATION OFFICERTr—
rr
OFFICE OF THE TOWN CLERK n
TOWN OF SOUTHOLD
DEC 121994 '!11
TO: Southold Town Building Department
BLDG.DEPT
FROM: Linda J. Cooper, Southold Town Clerk's Office 1 TOWN OF SOUTHOLD
DATED: December 12, 1994
Transmitted herewith is a copy of application No. 1310 for a Cesspool/
Septic Tank Construction Permit submitted by:
Matt Markowitz for Gregory Michaelakis •
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.
Y9" )--c-6
Linda J. Cooper
* * * * * * * * * * * *
I
have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments: Sc I Ai % .— c _0
0
R -41 N
--44° `
DEC 1 6 1994 slgn.tur=
torn Cle /P//5"7� 957
�
rk Solp� Dated
S 1
!. t
OFFICE OF THE TOWN CLERK """"
�� Town of Southold1-0
Judith T. Terry, Town Clerk � �OGy: Application No. .
Town Hall, 53095 Main Road = Construction
P. O. Box 1179
Southold, New York 11971 cwt) I Alteration ' ry
Telephone :0,�� ��r�'' $10.00 - Residential'
(516) 765-1801 _ '..1 I' •
$25.00 -Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE t f-6p
APPLICANT NAME: MAT. J1T '
APPLICANT ADDRESS: 3(G'l U iT 4S e-500(eer
ti J C M(( LOON
SEPTIC )( CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
?RY-W9 a A&(((/ C7et.1.-1A
1,Gytotte,9 Al1/462 170174647
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 4W-40R? 47
OWNER MAILING ADDRESS: ee -'Z1 t1Lgt Gj -
r k/(2000; /0.1 fl*S
OWNER PROPERTY ADDRESS: 06102 My(Atki toA9
VAVD 4
TELEPHONE NUMBER-OF CONTACT PERSON: (,��7j0-7 --c.9We
TAX MAP NO. : Section V7 Block ( Lot b 1/2
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE: 140. (n.4.66
/6°6/(;?ligr'li
RECEIVED Signature ,: ` �•,;, °•,, t
RECEIVED BY: C? 4�5 M0� R°
i e Office ft" ��` C24
*DATE: - �
Southold Town Clerk '
N a224eg.j '��•.,
-SOF NO
1
SUFFOLK CO. HEALTA DEPT.'APPROVAL'
1
`
• PLEASE NOTE '
; H.S . NO. i
Minimum distance between well �1
and cesspool is to be!150 feet. ` c. .v II/:'rxtfJ 6 I r �,
Q
\., EVIRES REE YEARS FROM DA . i _
- - - s 20'-.0' Via•_ _ -�- -T _ --- - - i� -46-A95 - -- _ 1 C� , �. �
T t 38 ¢. 9 0 _ b
- - _I _ -- _ -� . - s �.. , ! STATEMENTEN � .
'7-c> : vv&t _ - -- : - \3 , g l y A`1 S - J 7 _ _ tb/0 l - j Slone wall -.-$_. - t ,�`, I O F INTENT 1
t, t THE WATER SUPPLY AND SEWAGE DISPOSAL i
1t� ' � , �1�rBW�1 - - rI� J ✓�•, - &.--Iv .F4J n'A' ._- -- - i
`�` � d
.�•_ , ! �.- _ } '� i SYSTEMS FOR THIS RESIDENCE WILL (
Ire = — - - -- - -..
Q t ', CONFORM TO THE STANDARDS OF THE '
)60'odo - ----- prod° , T.
- E
�� \• r - _ - - _ _ ____ _ _ --_ -/ ___ __ �t� t l� SUFFOLK CO DEPT OF HEALTH SERVICES
\,+, `� �I APPLICANT
.. • d t prop. 1- —e`.:- f';.t gyp- bur(dl
q 1
I ,irob.seppc; 1 -feSr t1s, er► to �, �` `, SUFFOLK COUNTY DEPT. OF HEALTH
507 �x�rr , t�'J 0 } SERVICES - FOR APPROVAL FOR
� � v� X10 ti .
�_- , CONSTRUCTION ON Y
h ��� I- _,,�._.J — — -- - -- -- — 5 -, - — -- — -- t DATE: �'U�
.,
7... �;t H. S. REF. NO.. J /L'} ` rV
'Ai, � o ..th1. - l}6Z.5ZAPPROVED: �� _ �: .....
R. ,
J. /�'l. �f� a • _ �.
R• SUFFOLK CO. TAX MAP DESIGNATION:
\ • l t;lraca�f) L{ DIST. SECT. BLOCK PCL.
Ve±
' woo Z. 1 11..2
1 14%.
} OWNERS ADDRESS:
1 65-(7 ;71st 5frt-�e24-
1 �' ; V.C4F'/"4 S h �G-'d do(Cl 5, .'Sl. )! 113 6 5
0
• • . , • - ‘3°
ALA P Tl� 1�?7_ , \� '_` re/: 718 -9'61- 38z1
,,
SU�2i�` yEt7
PO 42 o 2. DEED: L. P. j
a Q TEST HOLE STAMP
/� ) J / ; G� author'zsd altercL`cn or addition
2 EE.J o Z Y �f c l E L..�_I _l 5 ,_ ``' :J is td this surrey is a v; sL'c::of
- �) 5 ct r 7208 of the Now York State
Sam.y u tion Law.
1 —/oar _ Oa iof reyoInd sI bearing ariog T 1 1 / t, andsuvsurveyor's Inked o or
e ossed sea/shall not be considered
ST �l-f f.��Q l�! • •
h1B'di&rrl t be a valid true copy.
'1.6n-rises are !o t Z oil- ,'fj p r o ve c� I SO pa Guarantees Indicated hereon shall run
Q�� Q T r_�Q.. �/ f M r r . / •
r•only to the person for whom iho survey
/ y --- /-d — — i; s[/r"�CJ/L /•✓` lot(11 M G/C� /C�, 1 g , — 3/�s Prepared.and on his behalf to the
t e company,governmerer ?gency and
c7 r- .41-o In E. -t Dc;/'"en4 k 1 £/p p tn. , Sl l t/ lending inst:iu'cr rsted herocn and
. - ' ---� ! ; tdthe assn c, ,, e i :rg Insti-
1
dT d tu�lon.Guarr L a�darable
i ., to add:tior.�.l i:-c.: ,�,:. c.s,2f3equent
— — _ 5� N 7o Hers.
Sanitary S�lS:�l7i iS r0t t0 be .sa rd$
11 .1 i
placedi,!!lu G�t'�VeUJ^ area.
9rcrt✓el re' T AL
/4.r4CCr - J�Jr, /9 7 SQ. f. Y a r, wet Br' 0 F11;
CGdr9t ')V.4;) R G<9•
t I �'c"i-ve d ale/77`. 30, /993 .surd of I * !iii "".6 r •-
a a i if 444 i %.r '11.4-± .11,A
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[q = tTfQttUx37Bt7f ( RODERICK VAN TUYL. P.C. 0 -
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t' LICENSED LAND SURVEYORS f{'
I _ GREENPORT NEW YORK - ,'