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ELIZABETH A.NEVILLE �� ''�: Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
-0
Southold, New York 11971
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REGISTRAR OF VITAL STATISTICS 1
MARRIAGE OFFICER " #41
y Fax Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �_�®. #0.01 Telephone Telephone (631) 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. 2485 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JASPER & MARY VEOUKAS
Address 1 : WOODCREST AVENUE
City St Zip RIVERHEAD NY 11901
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF # R10-00-0228
Name Of Owner VEOUKAS, JASPER
Mailing Address 1 WOODCREST AVENUE
City St Zip RIVERHEAD NY 11901
Property Address 1 HALLS CREEK DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 17 lot 17.029
Cross Street MEADOW BEACH LANE
Building Permit Number Cross Reference:
Issue Date: 12/29/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
of
k 001 OFFOCIC%., 3,2 C/K5
ELIZABETH A.NEVILLE �1� fid: Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER �1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =, ®� v�� ��i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER rrr
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 13, 2000
Transmitted herewith is a copy of application No. 2573 for a Cesspool/Septic Tank Construction
Permit submitted by:
Jasper & Mary Veoukas
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
Signature
I111 3 1 G ¢7
Dated
OFFICE OF THE TOWN CLERK ,." If UL�i/� _
TOWN OF SOUTHOLD �� �l`Q Application No. 7
PT.i7ABETH A.NEVILLE,TOWN CLERK �J1 •
P.O.BOX 1179 f Construction /fes
SOUTHOLD,NEW YORK 11971 • c=1 Alteration
•Telephone O,y �Q�•i: • $10.00 -Residential
(631) 765-1800 -x'01 *,;.' $25.00 -Non-Residential
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee *$
DATE 121 13 (d0
(-
APPLICANT NAME: J � C iv1-14tee( * V6O(-)l(8 S
APPLICANT ADDRESS: IN 00 V) C 12-6-5 c A-411=
V �-•1L-14-L-14
SEPTIC` CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
%Li 1 1-'( UJ LLc *Ye\
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 3 Rowe--re_ t le4.( Ue-OUId01-5
OWNER MAILING ADDRESS: IN 0 0 DCS it e-sr
OWNER PROPERTY ADDRESS: Tom!: - ; L_' I/
TELEPHONE NUMBER OF CONTACT PERSON:__7�� 3 L7
TAX MAP NO. : Section 115 Block t 1 Lot n- tai
CROSS STREET: iht0-1-5
BUILDING PERMIT NUMBER CROSS REFERENCE:
Qat.A.4-
Si
nature of Applicant
RECEIVED BY:
To n Cie k's Office
DATE: /
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HARBORPLwOT PLAN FOR
LOT 35
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MAP OF
EW AT MATTITUCK
FILE No. 8377 FILED AUGUST 21, 1987
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N 81•""I":,. I 4 TOWN OF SOUTHOLD
30" W tor , 4 SUFFOLK COUNTY, NEW YORK
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arsa, S.C. TAX No. 1000-115-17-17.29
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DOOM ELEVATIONS ASE S1101111 71109:1Q
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