HomeMy WebLinkAboutTsirkas 4,i.calf
ter;
Town Hall, 53095 Main Road
X 053
P.O. Box 1179
®Ai!� Southold, New York 11971
JUDITH T.TERRY ®� 01 FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
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. 579 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : DAC, CAMBRIA / POST & BEAM
Address 1 : 275 WEST MAIN STREET
City St Zip SAYVILLE NY 11782
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES.
Name Of Owner TSIRKAS, NICHOLAS
Mailing Address 1 35-04 208TH STREET
City St Zip BAYS!DE NY 11361
Property Address 1 SOUND DRIVE
City St Zip GREENPORT NY 11944
Tax Map No. section 33.00 block 1 lot 11 .000
Cross Street WESTWOOD LANE
Building Permit Number Cross Reference:
Issue Date: 2/01/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
D /,iii;•
r (BEOWEini
Ate " LW -
BLDG DEPT. ` l : r- 1) = li
TOWN OF
BLDG.
tfl `,'`' ;, t Town Hall, 53095 Main Road
v'' • ‘- 1 P.O. Box 1179
-T.::,04 y2.,. '�{I� Southold, New York 11971
JUDITH T.TERRY "PA�OAFil is{ 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: anuary 26, 1990
Transmitted herewith is a copy of application No. 591 for a Cesspool/
Septic Tank Construction Permit submitted by:
Cambria Dac of Post & Beam for Nicholas Tsirkas
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 Dc
DISAPPROVE
Comments: q„ --i[.trc. i arN Cakriaa C) C
C. N 11
Sig ature
Il 3)\c\ 0
Dated
w
/
OFFICE OF THE TOWN CLERK Oc0FOLeiD
Town of Southold 'V•ejs Application No. p
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road cnra ` RA Construction
P. O. Box 1179 li=d `
Southold New York 11971 � ® r gyp Alteration
0i_ 4 ''ai •' Residential
Telephone c
(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 .$
DATE
APPLICANT NAME: {/(1JH. _, e &.1. 1/N_
_, cP66 ' Bec,ryc
APPLICANT ADDRESS: 1 T. 0 . 'YY'? •
4-etba..1 ) n (ry ip-7 ?... ,
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
f
Al dt,b-Lai--L7 ,41A-- let•et-IQ— ,
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: l,,,,iia,„„ di
OWNER MAILING ADDRESS: 3 6- (9 ' aO F
-6i- OLLee_f
6 alL,LE , )41,- 113c,
OWNER PROPERTY ADDRESS: idAW ,Lcrat,t
A.9-4..i.
TELEPHONE NUMBER OF CONTACT PERSON: 7/ W--J.--2 - '' 3..-7
TAX MAP NO. : Section 0 S 3 Block I Lot // 3
- CROSS STREET: 1.A' :..fes- _.,t dip„ ,/
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY: _
Town Clerk's Office
DATE:
I r
f
A • SUFFOLK CO.HEALTH DEPT.APPROVAL N
e: / H.S. NO. i
50UN0 ! N
Nr
`1 ISt_ �r�'v
0
H 60.00.L 100 4•1
STATEMENT OF INTENT
0
:�ll ware' rrtar'k r THE WATER SUPPLY AND SEWAGE DISPOSAL
OI"cr• /
SYSTEMS FOR THIS RESIDENCE WILL
CONFORM TO THE STANDARDS OF THE
/ l\'-1 :4t=' 0.c.:-. P��Of�Ftl �" SUFFOL j el - 01 H�fTH SERVICES.
/� Ir , i j �1 C �, r•�y APPLICANT
�` Di SUFFOLK CO V"s • :.,- •' Q kYTH
t v, 1 OT II P / � ifir SERVICES -- FOR APPROVAL OF
r / 6�=_=l\r'f 'Uk�T CONSTRUCTION ONLY4
In �9 i l�/ r
N /; TOWN Of= :'C)(_1i 1-iC-:L_L,,NY. HAS REF.NO.• S' C�C� to
t_ APPROVED //
21 I SUFFOLK CO TAX MAP DESIGNATION
ti ! ` DIST ,000,SECT 03�,BLOCK I t PCL I I
Z e..11,:. I t� Q OWNERS ADDRESS•
e n' b e.` - 1�, _`r (J I:'‘401...—‘3Zl�`.lL2eSA:�
v __ 3J-04 `x',04=T1i „-7".
, r-----, _ - ~�. t
nSca/c.. .....1" (.rc'=-t.r_ r rrc ruae^r'� :freta/•: I-6,p..7,- !;, 3ra'•(SIUE i. 1 C
r o 1r TEL_. 718-22-4'Li273
(23' 1). (re6.) Or= rrtc`t.. I ,'f' "\ 'if.. ,ttr- LYf:r-e:r•'r Oiror . -:.;EY.f=ktr;' i'r,
Pft• 11 a,'- rr'(_'r1 pti.c• r r•-r,-.1 ,rr r1 r!• tlic.li_ '--Gtr n f hi Cle•-k,;.3
((. r // DEED• L.(hl('r+) P.
' v✓cJ r1 ` Ar marc! = .?..f..5,:.":.`_".,(1.:.,. , :ff-1(7c! .r_, hlap , 0. 4:1-7.1••--_3(,-.
r`; b1d1 U TEST HOLE STAMP
Jr'trcl -`Jto Unauthorized alteration or odikbn
to this survey is a violation of
T I Edducaati ionn law.the09 of New York Stinri
e'J (�'+ rtRP�Fr;"'t'a''"`l EAI;:';•`"�;:.�>�a ''!� !�1';"a
r% F t`!,' !tvirr'.'i yIE• 04'1 11 ' �ty''fi Capias of this survey mep not bearing
j,kr l ii..,:a: t4..Madtl rrct� ..,AtLCc z„�C,.,.-7•:•eo tY ` the land Surveyor a Inked seal or
'- embossed goal shall not be considered
,,C.
/ Vj r—, _ to be a valid true copy
II• � Guarantees Ind'rg•ed heron shall ran
1 -44 .i I :.:5 97 ,ly to the;.,•,,,,,f1nr,m 1 tci wthe survey
[_[a ,,,r=, and nn his o h,,-,•t to the
L - -- _ 1-IL. • • , c'onal arncy and
- - I 2.7`.i:� C_,J'1\ .`J .5,-•.:::"—',-.../_; N .._ — ' :,:...1 ,Ji ,• ,! ., J J.. ”.i 0r ,.le,c-ng
ensu_
r, !(Sl:r'/' .,.s;.,r • /0en,furable
., ,„ ,,,bsequent
pi
0 .,' ..r,.�1,_.f\:C L._>: .,\•.' i o_ of SEAL
S i C
1 I 0
,6 I 'I I.
_-,,)l-��u•e..-, 1 , r r-t
RODERICK VAN TUYL_P C ,
T. (;)- 1i LICENSED LAND SURVEl70RS
j GREENPORT NEW YORK