HomeMy WebLinkAboutGeorgiades, Vasilias OFFICE OF THE TOWN CLERK �FFDtAic"
Town of Southold O�Q 4G
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179to
Southold, New York 11971 j O
Telephone1 r
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 250 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
PERMIT ISSUED TO:
NAME: Vasilios and Maria Georgiades
ADDRESS: 30 Straw Lane
Hicksville, New York 11301
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New Single Family Dwelling •with Cesspool System.
APPROVED as per Suffolk County Health Department approval.
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Vasilios and Maria Georgiades
OWNER MAILING ADDRESS: 30 Straw Lane
Hicksville, New York 11301
OWNER PROPERTY ADDRESS: 56985 North Road
Greenport, New York 11944
TAX MAP NO. : Section 44 Block 1 Lot 29
CROSS STREET: Albertson Lane
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
' ud�th�T. Try
Southold Town Clerk
DATE: November 11, 1987
• (TOWN SEAL)
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Town Hall 53095 Main Road
v�i•' P.O. Box 728
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,,� Southold, New York 11971
JUDITH T.TERRY TELEPHONE
TOWN CLERK
(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD r6 1
To: Victor Lessard, Southold Town Building Department 7
From: Judith T. Terry, Southold Town Clerk BLS
TOWN OF SOUTHOLW
Transmitted herewith is a copy of application No. 254 for a
CONSTRUCTION or ALTERATION Permit for a cesspool or septic system
submitted by Vasilios and Maria Georgiades
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.
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 - 1
DISAPPROVE - AA 11 )14.--)1)
� np t�
• COMMENTS: Q, A 0� k,.� WU( en. er•
• de%.4 2"44j.
Signature
i '21
Date
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OFFICE OF THE TOWN CLERK c51F°Ce "'
Town of Southold r Town Clerk F�O "
CD� Application No.02,5
Judith T. Terry,
Town Hall, 53095 Main Road 8 _ j� Construction
P. O. Box 1179
Southold, New York 11971 `J Alteration
Telephone 40 * ��� •� 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 $(6 p%
DATE Nw, Co ( %7
APPLICANT NAME: VAS IL IO$ At— rh,NR,In GGOfQG$AO
APPLICANT ADDRESS: 3o S*Tigt4..W LA• H1c)kS' y kf. 11SOA
SEPTIC A CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
SILLS Vr4v4,44
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: VA$(L OS 4 n,,,,,+eal4 GeOgGleiDeS
OWNER MAILING ADDRESS: 3 / ( L -)E.
)..)iy i II3C��
OWNER PROPERTY ADDRESS: 5-
f\J0I2'TI-k Q
TELEPHONE NUMBER OF CONTACT PERSON: 4-33 --4CQICP
TAX MAP NO. : Section (344 Block Lot c2cj
CROSS STREET: 7 l.-Sea %0L) L �
BUILDING PERMIT NUMBER CROSS REFERENCE:
4// Q/N45,- 1-Qtkk)al-'4
Signature of Applicant„ � s
�.. Vow`• �(Uses • ���� e
RECEIVED BY:
Town Clerk's Office
DATE:
SUFFOLK COUNtY DEPT. OF HEALTH SERVICES SUFFOLK Cu. HEALTH DEPT. APPROVAL
1 ,
H. S NO.
FOR APPROVAL' OF CONSTRUCTION ONLY
DATE— 1 ' - KS. REF. NO.
i 4-,
. -- APPROVED -
STATEMENT OF INTENT
THE WATER SUPPLY AND SEWAGE: DISPO`
SYSTEMS FOR THIS RESIDENCE A.
CONFORM TO THE STANDARDS OF T
SUFFOLK CO DEPT. OF HEALTH SERVIC
(5)
( 1 3 ' c l fci i APPLICANT
i SUFFOLK COUNTY DEPT. OF HEAL
SUFFOLK COUNTY
DEPARTMENT OF HEALTH SERVICES SERVICES FOR APPROVAL
CONSTRUCTION ONLY
4
'1.'i FOR APPROVAL OF CONSTRUCTION ONLY DATE
5--L-3 H. S. REF. NO.
DATE -)- kr H. . REF. N a• APPROVED
APPROVED - SUFFOLK CO. TAX MAP DESIGNATION
YEARS FROM DATE OF APPROVAL DIST. SECT BLOCK PCL
EXPIRr,S TWO I i (CO—_ (:),4
OWNERS ADDRESS:
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FOR THIS RESIDENCE WILL CONFORM T,9/. HE.4C
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