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ELIZABETH A. NEVILLE �0 0 r �d Town Hall, 53095 Main Road
TOWN CLERK • re , ' P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ' Southold, New York 11971
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �% ,�, ��®il� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `t a
OFFICE OF THE TOWN CLERK
SOUTHOLD T MGWITIEMENSUERraciaszSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2592 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ZOUMAS CONTRACTING CORP
Address 1 : PO BOX 361
City St Zip WADING RIVER NY 11792
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 #R10-01-0055
Name Of Owner CAMBELL, JOHN
Mailing Address 1 29 FRESHWATER LANE
City St Zip HILTON HEAD SC 29928
Property Address 1 BUDDS POND ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 56.00 block 5 lot 7.000
Cross Street BAY HOME ROAD
Building Permit Number Cross Reference:
Issue Date: 5/30/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE �� � ‘0'0 Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER :jet
O � 1+, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ® �2, �' /� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `zs'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 18, 2001
Transmitted herewith is a copy of application No. 2680 for a Cesspool/Septic Tank Construction
Permit submitted by:
Zoumas for John &Virginia Campbell
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 AZ
DISAPPROVE
Comments:
ignature
Dated
• .v
•..•'/�FVolk4a .� . Application No.�
TOWN CLERK • OC,�
OFFICE OF THE .
TOWN OF SOUTHOLD •�• �, X'� F w'`° Construction-___ __
+ ,TOWN CLERK ' •
ELIZABETH A.t`EVU1E •F�{s��}��r� �fig
r�'�" t���� � �
P.O.BOX 1179r n Alteration
SOUTHOLD,h'EW YORK 11971 D 3' •• .
:� t�,�z� ,rO�. .•• $10.00 -Residential
Telephone :'O�-�'Q; ,.Jir �///�• $25.00 -Non-Residential
,(. ///
(516) 765-1801 �. ,,,...
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION •
for
•
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee *$ S /ga/
DATE
APPLICANT NAME: zOU id . .
.
:?;,p,p.•,Box 361
APPLICANT ADDRESS: b�aC�l11IVOrii
SEPTIC ✓ CESSPOOL I/ ALTERATION___________----DESCRIPTION OF PROPOSED CONSTRUCTION OR ALT
iffilliMit 0 • _
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•
LOCATION MAP: Must be attached hereto before permit may be Issued.
. .
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION
•. OWNER OF PROPERTY: Np �s1 1d�a' L A'
• OWNER MAILING ADDRESS: '4HNtc.a " ;��
.
. ► 1,-ro N - O0 G
•
•
OWNER PROPERTY ADDRESS: f dD I o'''
• TELEPHONE NUMBER OF CONTACT PERSON:
_____9c1 570
S Lot.,,....... --�-�•.-.-,.�.
•
Section . B{0 C{:
TAX MAP NO. : e _
CROSS STREET :
BUILDING PERMIT NUMBER CROSS REFERENCE:
SIJ
4,.�-, t
t Signa'!�a pp : '
1 RECEIVED BY: ___
f ___Town CCleerrk's Office
DATE: !_
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///
(7.8) • MAIN ROAD ( ROUTE 25 ) (7.2) t� CHANGE(
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by Dep:.__of Health_Services
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EXCAVATION INSPECTION RE9�GD N co 0 EXCAVATE LEACHING POOL A]'^;% 71
FORSANITARY SYSTEM (6.2) MIN. 3' FROM L.P.S. TO 6'E-i'_OW SEE SHEET 2 FOR SANITARY SYSTEM SECTION
. I r�sr Hae( ) SAND AND BACKFILL WffH C ?:AN SAND
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BY HEALTH DEPARTMENT 19.26' L=49.65' S 61'45'00�N ( 2�
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v ... SGTM: 1000-56-5-7 .
(6.1) BUDD'S POND ROAD (5.9) >' N.E "' }�1�1G LO S. NICOSIA, P.E. ;
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T 2 L,vt` .i 144 North Country y Read Port Jefferson,NY I ITT7
T1=/ .-4, #, 33 t. 631-428-2112 Fent 631-428-2163
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SITE PLAN SCALE i 90 4':.
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�'\`d f ��' ARSHAMOMAC�2UE, N.Y.
V TOWN OF SOUTHOLD
�0rEssts,
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`�-s.�..� SANITARY SYSTEM
,. Drawn i GJ5 IJob No,i Rev.: ISi,eeti
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HGUSE TOSEPTILTANK
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10'MIN PROPERTY'LINE —
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MEAN SEA LEVEL EL=O — ,
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SGTM 1000-56-5-1
SECTION A-A SCALE 3/16" _ l'-0" ,, ®V`Ne �- ANGELO 5. NICOSIA, P.E.
Lneer t Des
f,A - ev/ �® 144 North Country Road Port Jefferson,NY 11771
( °7 '''--.41-,r. cP 631-42b-2112 Fax 631-426-2163
Approvedi
,�r '�=1 ' aY SITE PLAN
%) `tV a ARSHAMOMAGUE, N.Y.
`� c3 TOWN OF SOUTHOLD
��6 No.063875 ft,
' - ��OFEssID�P� SANITARY SYSTEM
, _ Drown - , G.15 Job No., Rev., Sheet.
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