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JUDITH T. TERRYIP Town Hall, 53095 Main Road
TOWN CLERK ® r P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � Fax (516) 765 1823
MARRIAGE OFFICER �'ti ® •t�_�' Telephone (516) 765-1801
FREEDOM OF INFORMAT ON OFFICERRECORDS AGEMENT OFFICER
411 Prrrrr
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1193 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : BARBARA AND PAUL NAHAS
Address 1 : BOX 1226
City St Zip CUTCHOGUE NY 11935
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. #R10-94-0076
Name Of Owner NAHAS, PAUL AND BARBARA
Mailing Address 1 BOX 1226
City St Zip CUTCHOGUE NY 11935
Property Address 1 WELLS ROAD
City St Zip PECONIC NY 11958
Tax Map No. section 86.00 block 2 lot 11.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 8/29/94 Judith T. Terry
Southold Town, Clerk
(TOWN SEAL)
it
$c # Gym:
JUDITH T. TERRY : ` Town Hall, 53095 Main Road
TOWN CLERK p rZ P.O. Box 1179
to � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = V/o
�. Fax (516) 765-1823
MARRIAGE OFFICER j' OI�� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICERift �I�
FREEDOM OF INFORMATION OFFICER �. ,,,iii E "
IM
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OFFICE OF THE TOWN CLER J1G25l9g
AU4
TOWN OF SOUTHOLD j.
BLDG.DEPT
TO: Southold Town Building Department TQW1Y 9FSDUT OLL
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 24, 1994
Transmitted herewith is a copy of application No. 1239 for a Cesspool/
Septic Tank Construction Permit submitted by:
Barb and Paul Nahas
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: _5-c24 2 �
67/.4,2,/-
MOVED
r _r
AUG1994
Signatu
10 / 7
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OFFICE OF THE TOWN CLERK c.OFOL1 .
Town of Southold 0,0 CDS',
Judith T. Terry, Town Clerk :- ��: • Application No. / - '3y
Town Hall, 53095 Main Road ` o .', s h.' ;:4; Construction _
P. O. Box 1179 s*:
Southold, New York 11971 Alteration
� '� Residential '—
Telephone
�l ��i
(516) 765-1801 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ /o. do
DATE (� C Y , aV^ ( /
APPLICANT NAME: e- v___. /J-7/7 ,4s
APPLICANT ADDRESS: eG > lZ Z
(7_,Leic-4 (_1 ctL 7( .?' c---
SEPTIC
CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
fupcd ST7'vc.7 iv)71 - S ► nGr qtr f y
dwellr (9 I
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONS RUCTION OR ALTERATION: ,,
OWNER OF PROPERTY: /' c1I V 6GtQt/2
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OWNER MAILING ADDRESS: 6 9 12-2-6
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ae}r-e-ki 0 e__ 1) . L/ i /.?_35-
OWNER PROPERTY ADDRESS: God/.c 20( /c�on/'� )ICI/ /
TELEPHONE NUMBER OF CONTACT PERSON: 30z5"- - r o29 6
TAX MAP NO. : Section 08 6 Block (-9,_ Lot -/
CROSS STREET: Maw ed- Er: Z
BUILDING PERMIT NUMBER CROSS REFERENCE:
V&% % zLi
Signature of Applicant
RECEIVED BY: ,�/CJ (-�-�;
T wn Clerk's Office
DATE: 5(/g-4 0 c
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SUFFOLK CO. HEALTH DEPT. APPROVAL
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'''F.1 a STATEMENT OF INTENT
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�: , SYSTEMS FOR THIS RESIDENCE WILL
A• ! ; • CONFORM TO THE STANDARDS OF THE
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SUFFOLK CO. DEPT. OF HEALTH SERVICES.
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HEALTH SERVICES • f GREENPORT NEW YORKill _ _ r -
TELEDYNE POST N81329 • • r:
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