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HomeMy WebLinkAboutTheophilos • • OFFICE OF THE TOWN CLERK cOFULA-e, Town of Southold - G Judith T. Terry, Town Clerk .` Frr , % Town Hall, 53095 Main Road . aAI � ' P. 0. Box 1179 . b ' 'i • Southold, New York 11971 O•y �•'� Telephone f0l 1.14 ' , /,,"�" (516) 765-1801 TOWN OF,SOUTHOLD SOUTHOLD WASTEWATERDISPOSAL DISTRICT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 167 Residential x Non-Residential Fee $ 10.00 Septic Cesspool x PERMIT ISSUED TO: NAME: Hedwig Zervos ADDRESS: P.O. Box 2035 Orient, New York 11957 DESCRIPTION OF PROPOSED CONSTRUCTION or, ALTERATION New Single Family Dwelling with Sanitary System APPROVED as per Suffolk County Health Services approval LOCATION OF PROPOSED CONSTRUCTION or ALTERATION: -OWNER OF PROPERTY: Nick Theophilos OWNER MAILING ADDRESS: 387 'Broadway - New York, New YOrk 10013 OWNER PROPERTY ADDRESS : The Strand East Marion. New York TAX MAP NO. : Section 21 Block 5" .Lot 5 CROSS STREET: The Long Way BUILDING PERMIT NUMBER CROSS REFERENCE: , Ju id KT. Terry - Southold Town Clerk • DATE: May 29, 1987 (TOWN SEAL3 / 'c cIUlf( . . • k u--1 '``'l '?,r,F ,'�,1 N Town Hall, 53095 Main Road .• '' ' P.O. Box 1179 `';� �;� .�i Southold., New York 11971 JUDITH T. TERRY ��ii�i i>/A TELEPHONE TOWN CLERK - (516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK - TOWN OF SOUTHOLD May 29, 1987 Hedwig Zervos P.O. Box 2035 Orient, New York 11957 Re: Nick Theophilos The Strand East Marion, New York 11939 Enclosed herewith is the Construction, Alteration or Modification Permit for a Septic Tank or Cesspool System for which you applied. Please be advised that each owner of real property operating an on-site sewage disposal system, such as a septic tank or cesspool must, prior to such operation, possess in the name of the owner an Operation Permit for the system. The Operation Permit is issued by the Town Clerk's Office. The fee for an Operation Permit -is ten dollars ($10. 00) for residential use and twenty-five dollars ($25. 00) for non-residential. Please have the owner complete the enclosed Application for an Operation Permit and return it to this office along with the proper fee. For your general information I have enclosed an Informational Bulletin regarding the Scavenger Waste Laws adopted by the Southold Town Board. Should you have any questions pertaining to either permits or the Scavenger Waste Laws, please do not hesitate to contact this office. We will be glad to assist you in any way possible. , • Very truly ours, -tw.s4r 4.1•0514434044,s+ Judith T. Terry Southold Town Clerk Enclosures (3) JTT/Ijc iz:--- /6 7 • • C&rDU( ba c3 .. ' ,, N. `$ Town Hall, 53095 Main Road _..: ..war �' . N4 1W ill P.O. Box 728 "•A 4 ,00 Southold, New York 11971 Argitifr JUDITH T.TERRY TELEPHONE TOWN CLERK (516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD May 18, 1987 To: Victor Lessard, Southold Town Building Department From: Judith T. Terry, Southold Town Clerk Transmitted herewith is a copy of application No. 160 for a CONSTRUCTION or ALTERATION Permit for a cesspool or septic system submitted by Hedwig Zervos for Nick Theophilos . Please review the application and location map and advise if the project has received Suffolk County Health Department approval and if we may issue the permit. Please complete the form below and return it to my office. • Thank you. go•ateesp......040 ,„„0„,,,, 460040107......... , Judith T. Terry Southold Town Clerk * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendation: APPROVE - Y - DISAPPROVE - COMMENTS: n WL & 4Q1 - RECEIVED MY 2 81987 ,c, ., Signature Town Clerk Southold L/.1-4/V 7 Date OFFICE OF THE TOWN CLERK COFO(it-j Town of Southold ; Application No. L� 0 Judith T. Terry, Town Clerk Town Hall, 53095 Main Road Fi!{ : ; Construction • P. O. Box 1179 k : � J Alteration Southold, New York 11971 �- Telephone Olt �� Residential (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 $/6 -- DATE /bDATE h- � \ 1 c 1` S APPLICANT NAME: 1-4 Et LO 1G, S APPLICANT ADDRESS: O reO ' ta.o S epRiEHT SEPTIC CESSPOOL \/ DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION rrO 1•)S;T 1 U C_`1—t O 1) OF ME Ui H O V S G LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: M1C.4< T *EOP )-}1LbS OWNER MAILING ADDRESS:, �j$�`-( ' 3120 j)L ic0 NEW W Yc1K ) fI . loo I. OWNER PROPERTY ADDRESS: The StnGQ E ois$ Mcivv► o V\ N Py 119.-31 _ TELEPHONE NUMBER OF CONTACT PERSON�51.6)3 — TAX MAP NO. : Section 51 Block 5— Lot -164 .-24-- CROSS STREET: BUILDING PERMIT-- NUMBER CROSS REFERENCE: F 2J1�� z_� Sig rrture of Applicant RECEIVED Bqf ,LL_ RECEIVEDTown Clerk's ffice DATE: _ 4PR 21 1987 Town Chrk Soutnoio • ' SUFFOLK CO. HEALTH DEPT. APPROVAL H. S. NO. . 1 -t. �� ,S'I Nt /L.:7:v�q �., � ,(`� ,,w., ;,Kv)191 1 t�� �Y e; 'L.!`�V ter.��1 f`d l� �i1i L,1 . ' d f3..F? J".% D i Gw gtr^)NP,GVAL. / STATEMENT OF INTENT j I THE WATER SUPPLY AND SEWAGE DISPOSAL I 1 V SYSTEMS FOR THIS RESIDENCE WILL - -7 r' i c CONFORM TO THE STANDARDS OF THE if --- t.„:1::: � SUFFOLK CO. DEPT. OF HEALTH SERVICES. - � i_) (S) })E1w\€ •2-E Rvos k�`� .11 ' �� APPLICANT 2 � I i r L ksJlw'1 • v '� I I - SUFFOLK COUNT DEPT. OF HEALTH (, SERVICES — FOR APPROVAL OF !. + V Si " 1 l CONSTRUCTION ONLY, - t-- •-I"-••-0 1, + DATE: —/S'—e • a _l� _ / -- I ? H. S. REF. NO.: ' Kii �, • — ?•r 41 i T i • 1.'! , APPROVED:�a4 R 1 1 b w, ,1, r SUFFOLK CO. TAX MAP DES •• A 'ION: } DIST. SECT. BLOCK PCL. . s 1• / OWNERS ADDRESS: •i1.4---_..._ e.c-,'_ ____,j 38 7 Fre)add a j ,i j Ale i•41 ''o rk A/, }k! /4,0/3 I ? � .� i3 DEED: L. J�tiA P. , ' . 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